Background: We sought to quantify the risk trend of resternotomy coronary artery bypass grafting (CABG) over the past 2 decades. Methods: We compared the outcomes of 194 804 consecutive resternotomy CABG patients and 1 445 894 randomly selected first-time CABG patients (50% of total) reported to The Society of Thoracic Surgeons Adult Cardiac Surgery Database between 1999 and 2018. Primary outcomes were in-hospital mortality and overall morbidity. Using multiple logistic regression for each outcome for each year, we computed the annual trends of risk-adjusted odds ratios for the primary outcomes in the entire cohort and in 194 776 propensity-matched pairs. Results: The annual resternotomy CABG case volume from participating centers declined by 68%, from a median of 25 (range, 14-44) to a median of 8 (range, 4-15). Compared with first-time CABG, resternotomy CABG patients were consistently older, with higher proportions of comorbidities. After propensity matching, primary outcomes of resternotomy and first-time CABG were similar (mortality: 3.5% vs 2.3%, standardized difference [SDiff], 7.5%; morbidity: 40.7% vs 40.3%, SDiff, 0.9%). Mortality of resternotomy CABG performed after prior CABG was higher than that after prior non-CABG (4.3% vs 2.4%; SDiff, 10.8). Morbidity was similar between these subgroups (41.0% vs 39.1%; SDiff, 2.9). The adjusted odds ratio for mortality after resternotomy CABG declined from 1.93 (95% CI, 1.73-2.16) to 1.22 (95% CI, 0.92-1.62), and that of morbidity declined from 1.13 (95% CI, 1.08-1.18) to 0.91 (95% CI, 0.87-0.95), P < .001 for both. Conclusions: The risk of resternotomy CABG has decreased substantially over time. Resternotomy CABG performed after a prior CABG is higher risk compared with that performed after a non-CABG operation.
Bibliographical noteFunding Information:
This work was funded in part by Beare Foundation and the Hadassah Hebrew University Medical Center Research Fund 6071003 .
The data for this research were provided by The Society of Thoracic Surgeons National Database Participant User File Research Program. Data analysis was performed at the investigators’ institutions. The authors wish to thank Robert Habib, PhD, for his invaluable assistance, and Jonathan Rosenblatt for providing computing resources for this study. This work was funded in part by Beare Foundation and the Hadassah Hebrew University Medical Center Research Fund 6071003. The authors have no conflicts of interest to disclose.
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