ArticleInterdisciplinary cardiovascular and thoracic surgery2025
Coronary Artery Bypass Surgery in Patients on Dialysis: In-Hospital Outcomes from UK Registry Analysis.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesChronic kidney disease requiring dialysis significantly increases the risks of coronary artery disease. However, there is limited data on this high-risk patient population requiring coronary artery bypass grafting. Using a UK national registry, we investigated the impact of preoperative dialysis on in-hospital mortality and early morbidity in patients undergoing coronary artery bypass graft (CABG).
methodsA retrospective analysis of National Adult Cardiac Surgery Audit data between January 1996, 2, and March 31, 2019, identified patients who underwent first-time isolated CABG. Propensity matching was performed to balance the baseline characteristics between dialysis and non-dialysis patients, yielding 633 matched pairs. We evaluated trends in CABG among dialysis patients and EuroSCORE 2 performance in predicting in-hospital mortality (calibration, discrimination, and clinical utility).
resultsThere was a steep increase in CABG operations in dialysis patients after 2011. EuroSCORE 2 showed poor calibration, discrimination, and minimal clinical benefit in predicting mortality in dialysis cases. Dialysis patients exhibited a significantly higher in-hospital mortality rate (7.9% vs 2.1%, P < .001) than non-dialysis patients. The dialysis patients had longer median hospital stays (12 vs 9 days, P < .001) and a higher rate of return to the theatre for bleeding (5.5% vs 2.7%, P = .034). We found no difference in postoperative neurological deficit rates between the 2 cohorts. The odds ratio of in-hospital mortality for the dialysis vs non-dialysis patients was 4.62, P < .001, 95% (CI: 2.54-8.4). Significant predictors of mortality in the dialysis CABG cohort included advanced age (OR: 2.48), New York Heart Association class IV (OR: 3.06), and pulmonary hypertension (OR: 11.91).
conclusionsThere has been an overall increase in coronary artery bypass operations performed in renal dialysis-dependent patients in the UK. Preoperative chronic dialysis is associated with considerable in-hospital mortality, return to theatre for bleeding and prolonged hospital stay. EuroSCORE 2 has poor predictive performance in this patient cohort.
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