Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Surgery

Eeva-Maija Kinnunen (1) , Matti-Aleksi Mosorin (1) , Andrea Perrotti (2) , Vito G. Ruggieri (3) , Peter Svenarud (4) , Magnus Dalén (5) , Francesco Onorati (6) , Giuseppe Faggian (6) , Giuseppe Santarpino (7) , Daniele Maselli (7) , Carmelo Dominici (7) , Saverio Nardella (7) , Francesco Musumeci (8) , Riccardo Gherli (8) , Giovanni Mariscalco (9) , Nicola Masala (9) , Antonino S. Rubino (10) , Carmelo Mignosa (10) , Marisa de Feo (11) , Alessandro Della Corte (11) , Ciro Bancone (11) , Sidney Chocron (2) , Giuseppe Gatti (2) , Tatu Juvonen (1) , Fausto Biancari (1)

1 Oulu University Hospital [Oulu]
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
4 Karolinska University Hospital [Stockholm]
5 University Hospital of Verona
6 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
7 St Anna Hospital
8 S. Camillo-Forlanini Hospital
9 University Hospitals Leicester
10 Morgagni-Pierantoni Hospital
11 University of Naples Federico II = Università degli studi di Napoli Federico II

Objective The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative complications in patients undergoing coronary artery bypass grafting (CABG). Design Retrospective, observational study. Setting University hospital. Participants A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG. Interventions Isolated CABG. Measurements and Main Results The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all-cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p<0.0001) and adjusted analysis (p<0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p<0.0001). The grading method (p<0.0001) and the additive score (rho, 0.514; p<0.0001) were predictive of the length of intensive care unit stay. Conclusions The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surgery

Mots clés: Cardiac surgery; classification; complication; coronary artery bypass grafting

Domaines: Sciences du Vivant [q-bio]

Eeva-Maija Kinnunen, Matti-Aleksi Mosorin, Andrea Perrotti, Vito G. Ruggieri, Peter Svenarud, et al.. Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 2015, In press. ⟨10.1053/j.jvca.2015.09.019⟩. ⟨hal-01259442⟩