背景:酒精滥用(AA)的患病率很高,影响了1000万到1500万美国人。虽然AA被证明会对心血管健康产生负面影响,现有研究的有限证据表明,AA对冠状动脉旁路移植术(CABG)结局的影响存在矛盾.本研究旨在比较AA和非AA患者CABG术后的住院结局。
方法:在2015-2020年第四季度的全国住院患者样本中确定了接受CABG的患者。排除标准包括年龄<18岁和伴随程序。1:3倾向得分匹配用于解决人口统计学差异,社会经济地位,主要付款人身份,医院特色,合并症,AA和非AA患者之间的转移/入院状态。检查CABG后的院内结局。
结果:有5,694(3.39%)的AA患者行CABG。匹配后,来自162,488名非AA患者的17,315名与所有AA患者相匹配。AA和非AA患者的死亡率相当(1.64%vs1.55%,p=0.67)和MACE(2.46%对2.56%,p=0.73)。然而,AA患者心源性休克发生率较高(8.31%vs7.43%,p=0.03),机械通气(11.51%vs7.96%,p<0.01),出血/血肿(57.49%vs54.75%,p<0.01),浅层(0.99%对0.61%,p<0.01)和深部伤口并发症(0.37%vs0.18%,p=0.02),重新开放手术以控制出血(0.92%vs0.63%,p=0.03),转出(21.00%对16.38%,p<0.01),从入院到手术的时间更长(p<0.01),住院时间更长(p<0.01),医院收费较高(p<0.01)。
结论:虽然未发现AA与CABG后住院死亡率或MACE相关,与术后并发症独立相关.这些发现可以增强AA患者的术前风险分层,并为CABG后的术后管理提供信息。
BACKGROUND: Alcohol abuse (AA) has s high prevalence, affecting 10 to 15 million Americans. While AA was demonstrated to negatively impact cardiovascular health, limited evidence from existing studies presents conflicting findings regarding the effects of AA on coronary artery bypass grafting (CABG) outcomes. This
study aimed to compare the in-hospital outcomes after CABG between AA and non-AA patients.
METHODS: Patients who underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Exclusion criteria included age<18 years and concomitant procedures. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between AA and non-AA patients. In-hospital outcomes after CABG were examined.
RESULTS: There were 5694 (3.39%) AA patients who underwent CABG. After matching, 17,315 from 162,488 non-AA patients were matched to all AA patients. AA and non-AA patients had comparable mortality (1.64% vs 1.55%, p = 0.67) and MACE (2.46% vs 2.56%, p = 0.73). However, AA patients had higher cardiogenic shock (8.31% vs 7.43%, p = 0.03), mechanical ventilation (11.51% vs 7.96%, p < 0.01), hemorrhage/hematoma (57.49% vs 54.75%, p < 0.01), superficial (0.99% vs 0.61%, p < 0.01) and deep wound complications (0.37% vs 0.18%, p = 0.02), reopen surgery for bleeding control (0.92% vs 0.63%, p = 0.03), transfer out (21.00% vs 16.38%, p < 0.01), longer time from admission to operation (p < 0.01), longer length of stay (p < 0.01), and higher hospital charge (p < 0.01).
CONCLUSIONS: While AA was not found to be linked with in-hospital mortality or MACE after CABG, it was independently associated with postoperative complications. These findings could enhance preoperative risk stratification for AA patients and inform postoperative management following CABG.