The effect of preoperative liver dysfunction on cardiac surgery outcomes

• Main Authors: Luiz Araujo, Viktor Dombrovskiy, Wali Kamran, Ashleigh Lemaire, Antonio Chiricolo, Leonard Y. Lee, Anthony Lemaire
• Format: Article
• Language: English
• Published: BMC 2017-09-01
• Series: Journal of Cardiothoracic Surgery
• Subjects: Coronary artery disease; Cirrhosis; Heart failure; Bleeding
• Online Access: http://link.springer.com/article/10.1186/s13019-017-0636-y

Abstract Background To determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS). Methods The Nationwide Inpatient Sample (2002–2010) was queried to identify patients with LD who had elective CABG or VS utilizing ICD-9-CM diagnosis and procedure codes. These patients were matched with the similar patients without LD (controls) by propensity score matching. Chi-square and Wilcoxon rank sum tests were used for analysis. Results We identified 1197 patients with LD (CABG = 755; VS = 442) who were matched to 2394 controls. LD significantly increased hospital mortality after both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 7.49; 95%CI = 3.12–17.96). Overall rates of complications after CABG with LD were greater than in non-complicated cases (OR = 1.73; 95%CI = 1.46–2.05). Among them, there was an increase in bleeding (OR = 1.81;95%CI = 1.44–2.28), respiratory (OR = 2.33;95%CI = 1.86–2.93), renal (OR = 2.79;95%CI = 2.04–3.81), and infectious (OR = 2.93;95%CI = 2.14–4.01) complications. In general, the rates of complications after VS with LD were also greater than in non-complicated cases (OR = 2.77;95%CI = 2.13–3.60), specifically for bleeding (OR = 3.07;95%CI = 2.17–4.34), respiratory (OR = 3.57;95%CI = 2.51–5.07), renal (OR = 4.40;95%CI = 2.80–6.92), and infectious (OR = 4.63;95%CI = 2.85–7.51) complications. The development of LD significantly increased mean hospital length of stay (LOS) and total hospital charges after both CABG (from7.0 ± 4.0 to 9.2 ± 9.1 days and from $100,265 ± 87,107 to $117,756 ± 99,320, respectively; P < 0.0001 for both) and VS (from 7.9 ± 5.0 to 11.4 ± 9.9 days and from $134,306 ± 114,216 to $176,620 ± 147,049, respectively; P < 0.0001 for both). Conclusions LD worsened the outcomes after cardiac surgery. It increased rates of complications, hospital mortality, length of stay and total hospital charges after both procedures.