Key result
Among 614,161 patients undergoing major cardiac surgery in Asia-Oceania, CABG was associated with lower hospital mortality compared to heart valve procedures (1.97% vs 3.97%).
Why the study?
Evidence on the burden of postsurgical complications has derived mainly from Western countries, with little known in the Asia-Oceania region.
Meta-Analysis (n=614,161)
Yes
Absolute Event Rate: 1.97% vs 3.97%
In Asia-Oceania countries, major cardiac surgeries are associated with a 2.38% hospital mortality and 17.49% incidence of postoperative atrial fibrillation, with worse outcomes observed in heart valve procedures compared to CABG.
BACKGROUND: Evidence on the burden of postsurgical complications is mainly from studies in western countries, and little is highlighted in the Asia-Oceania region. This study aimed to identify and compare the burden of postsurgical complications in major cardiac surgeries in Asia-Oceania countries. METHODS: A systematic search was performed in PubMed, Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria were: (a) observational studies or randomized control trials; (b) studied in coronary artery bypass graft (CABG) and/or heart valve procedures; (c) measured postsurgical clinical outcomes; and (d) conducted in Asia-Oceania countries. Pooled effects were calculated using a random-effects model. RESULTS: Of the 6032 articles screened, 472 studies with a total of 614 161 patients met the inclusion criteria. The pooled incidences (95% confidence interval) of hospital mortality and 30-day mortality were similar at 2.38% (2.16%-2.59%) and 2.33% (2.16%-2.50%), respectively. Length of stay (LOS) was 14.07 days (13.44-14.71 days). The incidence for atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was 17.49% (15.99%-18.99%) and 1.64% (1.51%-1.78%), respectively. Below outcomes tended to be better in studies on CABG compared to heart valve procedures, including the incidence of hospital mortality (1.97%[1.75%-2.18%] vs 3.97% [3.29%-4.65%]), AF (16.47% [14.85%-18.10%] vs 21.98% [17.41%-26.54%]), stoke/CVA (1.51% [1n 37%-1.65%] vs 2.55% [2.07%-3.04%]), and mean LOS (days) (13.08 [12.51-13.65] vs 19.58 [16.72-22.45]). Similarly, all postsurgical complications tended to be higher in studies involving high-risk patients vs non-high-risk patients. CONCLUSIONS: There are opportunities to improve clinical outcomes of patients with high surgical risks and those undertaking heart valve procedures, as they tend to have poorer survival and higher risk in developing postsurgical complications.
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Dhippayom et al. (2020) conducted a meta-analysis in Major cardiac surgeries (n=614,161). Coronary artery bypass graft (CABG) vs. Heart valve procedures was evaluated on Hospital mortality. Among 614,161 patients undergoing major cardiac surgery in Asia-Oceania, CABG was associated with lower hospital mortality compared to heart valve procedures (1.97% vs 3.97%).
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