Atrial fibrillation, major bleeding, heart failure, and postoperative complications in patients undergoing isolated on-pump coronary artery bypass grafting in the northeast of Iran: A retrospective cohort study

Abstract

Coronary artery bypass grafting (CABG) is one of the most performed cardiothoracic surgeries worldwide. The aim was to assess postoperative complications of patients undergoing CABG in the northeast of Iran. This was a 10-year, large-scale retrospective cohort study in Golestan Province. Kordkuy Heart Center of Amiralmomenin Hospital and Shafa Private Heart Center were the study settings, which were the only heart centers providing services to patients with cardiovascular diseases in Golestan Province. Adult patients of both genders who underwent isolated on-pump CABG procedures between 2007 and 2016 were included, and postoperative complications were extracted directly from patients' hospital records. Out of 3720 surgeries performed, 3704 eligible patients were recruited, with a mean (standard deviation) age of 59.0 (9.8) years, of whom 73% were male. The postoperative complications included acute atrial fibrillation (AF; 8.2%), major bleeding (3.5%), heart failure (HF) (3.1%), pneumonia (2.0%), myocardial infarction (1.3%), acute kidney injury (1.0%), and stroke (0.3%). According to multivariable analyses, age (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.001, 1.02; P .028), left ventricular ejection fraction (OR 0.97, 95% CI 0.96, 0.99; P .004), and preoperative β-blocker (OR 1.31, 95% CI 1.02, 1.68; P .034) were associated with new-onset AF. Cardiopulmonary bypass time (OR 1.003, 95% CI 1.001, 1.006; P .042) was the only associated factor with postoperative major bleeding. Chronic obstructive pulmonary disease (OR 6.73, 95% CI 3.98, 11.40; P < .001), preoperative β-blocker (OR 2.60, 95% CI 1.69, 3.97; P < .001), and preoperative angiotensin-converting-enzyme inhibitors (OR 1.56, 95% CI 1.04, 2.33; P .029) were the associated factors with postoperative HF. In conclusion, acute AF, major bleeding, HF, pneumonia, myocardial infarction, acute kidney injury, and stroke were postoperative complications observed in patients undergoing isolated on-pump CABG.

Keywords: Iran; coronary artery bypass; postoperative complications; retrospective studies.