In-Hospital Mortality After Coronary Artery Bypass Graft Surgery With and Without Systemic Lupus Erythematosus

Background/Objective: To evaluate in-hospital mortality after coronary artery bypass graft (CABG) surgery in patients with and without systemic lupus erythematosus (SLE) using a large contemporary nationwide inpatient database. Methods: Using the 2016 to 2022 National Inpatient Sample database, we identified adults undergoing CABG surgery and compared those with and without SLE. Demographics, comorbidities, socioeconomic factors, and perioperative outcomes were analyzed. Multivariable logistic regression was used to assess factors associated with in-hospital mortality. Results: Among 1,342,510 CABG hospitalizations, 4260 (0.3%) involved patients with SLE. Compared with non-SLE patients, those with SLE were younger (median 63 vs. 67; P <0.001), predominantly female (72.9% vs. 24.1%; P <0.001), more likely to be African American (20.8% vs. 6.7%; P <0.001), had higher comorbidity scores (median Charlson Comorbidity Index: 4 vs. 2; P <0.001), longer median hospital LOS (9 vs. 8 d; P <0.001), and higher median total hospital charges ($206,441 vs. $186,257; P <0.001). SLE itself was not independently associated with in-hospital death (adjusted OR: 0.92; 95% CI: 0.635-1.340). Factors independently associated with in-hospital mortality included older age, female sex, concurrent valve surgery, and greater comorbidity burden. Higher-income quartiles and private insurance were protective. Rates of major perioperative complications were generally similar between the groups, although respiratory failure occurred more frequently in SLE patients. Conclusions: After adjusting for demographic and clinical factors, SLE was not independently associated with mortality during CABG surgery hospitalization. These findings suggest that SLE alone may not independently increase in-hospital mortality risk after CABG surgery.