Key result
LVEF ≤20% in nonemergent CABG is linked to ~7% mortality and higher direct costs.
Why the study?
Preoperative LVEF is a main predictor of cardiac surgery outcomes, prompting an evaluation of current-era outcomes and direct costs in nonemergent isolated CABG patients with LVEF <20% compared with higher EF subgroups.
Does preoperative LVEF ≤20% compared to higher LVEF increase mortality and direct costs in patients undergoing nonemergent isolated CABG?
Cohort (n=10,993)
Yes
Does preoperative LVEF ≤20% compared to higher LVEF increase mortality and direct costs in patients undergoing nonemergent isolated CABG?
Absolute Event Rate: 6.9% vs 1.6%
In nonemergent isolated CABG, patients with LVEF ≤20% have significantly higher mortality, complication rates, and direct costs of care compared to those with higher ejection fractions.
Patients with LVEF ≤20% face higher mortality and costs after nonemergent CABG; leaves open whether targeted strategies improve outcomes in this subgroup.
OBJECTIVE: Preoperative left ventricular ejection fraction (LVEF) is one of the main predictors of outcomes in cardiac surgery. We present current era outcomes and associated direct cost in nonemergent isolated coronary artery bypass surgery (CABG) patients with LVEF <20% over the past 6 years and compare it with higher EF subgroups. METHODS: Six-year data from 2016 to 2022 at hospitals sharing Society of Thoracic Surgeons and financial data with Biome Analytics were analyzed based on 3 EF subgroups (EF ≤20%, EF 21% to 35%, and EF >35%). Outcomes and costs were assessed. RESULTS: = 10,993) cohorts had mortality of 6.9%, 3.7%, and 1.6%, respectively. The EF ≤20% subgroup had higher use of cardiopulmonary bypass, blood products, and mechanical support. In addition, the EF ≤20% subgroup had higher complication rates in almost all measured categories. Also, the EF ≤20% cohort had significantly higher length of stay, intensive care unit (ICU) hours, ICU and hospital readmissions, and lowest discharge to home rate. The strongest factors associated with mortality were postoperative cardiac arrest, renal failure requiring dialysis, extracorporeal membrane oxygenation, sepsis, prolonged ventilation, and gastrointestinal event. The overall median direct cost of care was $37,387.79 ($27,605.18, $51,720.96), with a median direct cost of care in the EF ≤20%, EF 21% to 35%, and EF >35% subgroups of $52,500.17 ($34,103.52, $80,806.79), $44,108.32 ($31,597.58, $63,788.03), and $36,521.80 ($27,168.91, $50,019.31), respectively. CONCLUSIONS: In nonemergent isolated CABG surgery, low EF continues to have higher surgical risks and higher direct cost of care despite advances in cardiovascular care.
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Gulkarov et al. (2023) conducted a cohort in Nonemergent isolated coronary artery bypass surgery (CABG) (n=10,993). LVEF ≤20% vs. LVEF 21% to 35% and LVEF >35% was evaluated on Mortality. In nonemergent isolated CABG, patients with LVEF ≤20% had higher mortality (6.9%) compared to those with LVEF 21-35% (3.7%) and >35% (1.6%), and higher median direct costs ($52,500 vs $36,521).
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