Sunday, December 24, 2006

Peripheral Vascular Disease and Outcomes Following Coronary Artery Bypass Graft Surgery

Ted Collison, MD; J. Michael Smith, MD; Amy M. Engel, MA

Arch Surg. 2006;141:1214-1218.

Hypothesis There is an increased operative risk in patients with a history of peripheral vascular disease (PVD) who undergo coronary artery bypass grafting (CABG). There are also outcome differences associated with these patients.

Design A study from a 10-year hospitalization cohort with prospective data collection.

Setting Multiple hospitals in the Greater Cincinnati area with 1 surgical group of cardiac surgeons.

Participants Cases were CABG patients with PVD, which was defined as having a history of type 1 neurologic injury, prior vascular surgery, or current vascular disease (n = 1561). Controls were CABG patients without PVD (n = 6328).

Interventions The study examined 42 potential confounding risk factors and 16 outcome variables.

Results Twenty-nine potential risk factors were found to be significantly different between CABG patients with and without PVD. Twenty-six confounding risk factors were correlated with 3 factors. Logistic regression analysis showed that even after controlling for sex, significant associative disorders, and other procedures, CABG patients with PVD still experienced more arrhythmias requiring treatment (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.03-1.33; P = .01), neurological complications (OR, 1.7; 95% CI, 1.43-2.07; P<.001), pulmonary complications (OR, 1.4; 95% CI, 1.23-1.62; P<.001), low output (OR, 1.3; 95% CI, 1.09-1.45; P = .001), and intraoperative complications (OR, 1.39; 95% CI, 1.06-1.83; P = .02).

Conclusions Patients with a PVD history undergoing CABG had more coexistent risk factors. These patients also exhibited higher rates of cardiac, systemic, renal, neurologic, and pulmonary complications.

Author Affiliations: Department of Surgery, Good Samaritan Hospital (Drs Collison and Smith), Cardiac, Vascular, and Thoracic Surgery, Inc (Dr Smith), and E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio (Ms Engel).


dr peg said...

Jeff - What happened to your creative writing blog?

Jeff said...

When I tried to move it to beta, I lost it and am too busy to start it again. I am preparing the manuscript of the revsion of my book, The Ghosts of November and am actively seeking a new publisher. Thanks for asking.

dr peg said...

Jeff - I "googled" your book. It looks gripping. I'm going to look for it in our public library. I'd be interested to know why you're revising it. But I know you're busy doing it so don't worry about answering - I'm sure I'll find out when the new version comes out.

Congratulations on being a published author. I'm hoping to be the same in another year (see my blog). It's always gratifying to learn of someone else's success. Best to you!


dr peg said...

Well, guess what? You're collectible! Or rather, your book is collectible. ;)

Our library doesn't have it. Amazon has some "not new" copies, all priced at least twice the original price, one marked "collectible" and "signed by the author."

I think I see the reason for the revision. Good luck!