National Variation in the Use of Multiple Arterial Grafting in Isolated Coronary Artery Bypass Grafting in the United Kingdom.

objectivesThe last 2 decades have seen a reduction in the use of multiple arterial grafting (MAG) worldwide. The increase in risk profile in patients undergoing coronary artery bypass grafting (CABG) has been suggested as a cause for this limited use. This study aims to evaluate national variation at the surgeon and hospital level in the use of MAG while considering patients' risk profiles.

methodsAll patients who underwent first-time, elective/urgent, isolated CABG in the United Kingdom from 2010 to 2019 were included from the national adult cardiac surgery database. MAG was defined as the use of 2 or more arterial grafts. A 3-level multilevel logistic regression models (level 1: patients, level 2: surgeons, and level 3: hospitals) were used to estimate the variation in the use of MAG at each level.

resultsForty hospitals were identified, in which the MAG use ranged from 0% to 43.79%. A total of 135 978 patients were included in the study, of which 15 310 (11.3%) received MAG. Younger (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.06-1.06, P < .001), male (OR: 1.14, 95% CI: 1.09-1.19, P < .001), and patients with fewer comorbidities and a higher socioeconomic status were more likely to receive MAG. After propensity score matching, there was no differences between patients who received single or MAG in in-hospital survival (0.8% vs 1.1%, P = .11), return to theatre for bleeding (3.3% vs 3.6%, P = .23), post-operative stroke (0.5% vs 0.3%, P = .08), and deep sternal wound infection (0.8% vs 0.8%, P = .66). Overall, surgeons' and hospitals' volumes were not associated with the use of MAG. However, surgeons with a higher volume of off-pump CABG were more likely to offer MAG (OR: 1.37, 95% CI: 1.31-1.42, P < .001). The interclass correlation coefficient was 0.31 at the surgeon level and 0.20 at the hospital level, implying 31% of the variability in the use of MAG is due to systematic differences between surgeons, and 20% due to systematic differences between hospitals.

conclusionsOur results demonstrate a considerable variation in both individual surgeons and hospital levels in the use of MAG. Young males with few comorbidities and higher socioeconomic status were more likely to be recipients of MAG. The use of multiple arterial grafts did not seem to increase the incidence of early in-hospital major complications.