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Ted Collison, MD; J. Michael Smith, MD; Amy M. Engel, MA

Arch Surg. 2006;141:1214-1218.

Hypothesis  There is an increased operative risk in patients with a history of peripheral vascular disease (PVD) who undergo coronary artery bypass grafting (CABG). There are also outcome differences associated with these patients.

Design  A study from a 10-year hospitalization cohort with prospective data collection.

Setting  Multiple hospitals in the Greater Cincinnati area with 1 surgical group of cardiac surgeons.

Participants  Cases were CABG patients with PVD, which was defined as having a history of type 1 neurologic injury, prior vascular surgery, or current vascular disease (n = 1561). Controls were CABG patients without PVD (n = 6328).

Interventions  The study examined 42 potential confounding risk factors and 16 outcome variables.

Results  Twenty-nine potential risk factors were found to be significantly different between CABG patients with and without PVD. Twenty-six confounding risk factors were correlated with 3 factors. Logistic regression analysis showed that even after controlling for sex, significant associative disorders, and other procedures, CABG patients with PVD still experienced more arrhythmias requiring treatment (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.03-1.33; P = .01), neurological complications (OR, 1.7; 95% CI, 1.43-2.07; P<.001), pulmonary complications (OR, 1.4; 95% CI, 1.23-1.62; P<.001), low output (OR, 1.3; 95% CI, 1.09-1.45; P = .001), and intraoperative complications (OR, 1.39; 95% CI, 1.06-1.83; P = .02).

Conclusions  Patients with a PVD history undergoing CABG had more coexistent risk factors. These patients also exhibited higher rates of cardiac, systemic, renal, neurologic, and pulmonary complications.

Author Affiliations: Department of Surgery, Good Samaritan Hospital (Drs Collison and Smith), Cardiac, Vascular, and Thoracic Surgery, Inc (Dr Smith), and E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio (Ms Engel).

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Peripheral Vascular Disease and Outcomes Following Coronary Artery Bypass Graft Surgery—Invited Critique
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Arch Surg. 2006;141(12):1219.
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