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Arch Surg. 2002;137:428-433.

Hypothesis  Comorbid conditions are associated with the risk of death from coronary artery bypass graft surgery.

Design  Prospective cohort study data were collected on patient and disease characteristics and comorbid conditions including hypertension, diabetes, obesity, vascular disease, chronic obstructive pulmonary disease, cancer (excluding nonmelanoma skin cancer), dialysis-dependent renal failure, liver disease, and dementia. Statistical analysis used logistic regression for the calculation of adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Setting  Regional cardiac surgery database.

Patients  A total of 27 239 consecutive patients undergoing isolated coronary artery bypass graft surgery.

Main Outcome Measure  In-hospital mortality rate.

Results  The prevalence of comorbid conditions was as follows: hypertension, 64.3%; diabetes, 30.1%; obesity, 24.6%; severe obesity, 7.2%; vascular disease, 18.3%; chronic obstructive pulmonary disease, 10.9%; peptic ulcer, 7.5%; cancer, 3.8%; renal failure, 1.5%; liver disease, 0.6%; and dementia, 0.1%. After adjustment for patient and disease characteristics, including age, sex, previous cardiac surgery, priority of surgery, degree of left main coronary stenosis, number of diseased coronary arteries, and left ventricular ejection fraction, the following comorbid conditions were significant predictors of in-hospital mortality: diabetes (OR, 1.19; 95% CI, 1.01-1.40; P = .03), vascular disease (OR, 1.67; 95% CI, 1.41-1.97; P<.001), chronic obstructive pulmonary disease (OR, 1.57; 95% CI, 1.29-1.91; P<.001), peptic ulcer (OR, 1.34; 95% CI, 1.05-1.71; P = .02), and dialysis-dependent renal failure (OR, 3.68; 95% CI, 2.65-5.13; P<.001). There was no significant association between in-hospital mortality and hypertension, obesity or severe obesity, cancer, liver disease, or dementia.

Conclusion  Even after adjustment for other patient and disease characteristics, comorbid conditions (especially diabetes, vascular disease, chronic obstructive pulmonary disease, peptic ulcer disease, and dialysis-dependent renal failure) are associated with significantly increased risk of death after coronary artery bypass graft surgery.

From the Departments of Surgery, Eastern Maine Medical Center, Bangor (Drs Clough and Hernandez), Fletcher-Allen Health Care, Burlington, Vt (Dr Leavitt), Maine Medical Center, Portland (Dr Morton), Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Plume and Nugent), and Worcester Medical Center, Worcester, Mass (Dr Lahey); and the Departments of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Ms Ross and Dr O'Connor). A complete list of the members of the Northern New England Cardiovascular Disease Study Group was published previously (Ann Thorac Surg. 2001;71:775-776).

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