The effect of preoperative liver dysfunction on cardiac surgery outcomes

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.