Combined CABG and multiple valve surgery was associated with the highest risk of 1-year disability compared to isolated CABG (13.1% vs 4.6%, HR 1.78).
Cohort (n=72,824)
Yes
Does the type of major cardiac surgery (valve or combined procedures) increase the risk of disability compared to isolated CABG in adults aged ≥40 years?
The cumulative incidence of patient-defined disability at 1 year is lowest after isolated CABG and highest after combined CABG and multiple valve surgery, highlighting the need for personalized disability risk prediction.
Effect estimate: HR 1.78 (95% CI 1.43-2.23)
Absolute Event Rate: 13.1% vs 4.6%
BACKGROUND: Cardiovascular research has traditionally been dedicated to "tombstone" outcomes, with little attention dedicated to the patient's perspective. We evaluated disability-free survival as a patient-defined outcome after cardiac surgery. METHODS: We conducted a retrospective cohort study of patients aged 40 years and older who underwent coronary artery bypass grafting (CABG) or single or multiple valve (aortic, mitral, tricuspid) surgery in Ontario between Oct. 1, 2008, and Dec. 31, 2016. The primary outcome was disability (a composite of stroke, 3 or more nonelective hospital admissions and admission to a long-term care facility) within 1 year after surgery. We assessed the procedure-specific risk of disability using cumulative incidence functions, and the relative effect of covariates on the subdistribution hazard using Fine and Gray models. RESULTS: The study included 72 824 patients. The 1-year incidence of disability and death was 2431 (4.6%) and 1839 (3.5%) for CABG, 677 (6.5%) and 539 (5.2%) for single valve, 118 (9.0%) and 140 (10.7%) for multiple valve, 718 (9.0%) and 730 (9.2%) for CABG and single valve, and 87 (13.1%) and 94 (14.1%) for CABG and multiple valve surgery, respectively. With CABG as the reference group, the adjusted hazard ratios for disability were 1.34 (95% confidence interval CI 1.21-1.48) after single valve, 1.43 (95% CI 1.18-1.75) after multiple valve, 1.38 (95% CI 1.26-1.51) after CABG and single valve, and 1.78 (95% CI 1.43-2.23) after CABG and multiple valve surgery. Combined CABG and multiple valve surgery, heart failure, creatinine 180 μmol/L or greater, alcohol use disorder, dementia and depression were independent risk factors for disability. INTERPRETATION: The cumulative incidence of disability was lowest after CABG and highest after combined CABG and multiple valve surgery. Our findings point to a need for models that predict personalized disability risk to enable better patient-centred care.
Sun et al. (Thu,) conducted a cohort in Major cardiac surgery (n=72,824). Combined CABG and multiple valve surgery vs. Isolated CABG was evaluated on Disability (composite of stroke, ≥3 nonelective hospital admissions, and long-term care admission) within 1 year (HR 1.78, 95% CI 1.43-2.23). Combined CABG and multiple valve surgery was associated with the highest risk of 1-year disability compared to isolated CABG (13.1% vs 4.6%, HR 1.78).