Section of Cardiac Surgery Yale School of Medicine New Haven CT.
Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.
J Am Heart Assoc. 2020 Oct 20;9(20):e016980. doi: 10.1161/JAHA.120.016980. Epub 2020 Oct 13.
Background The likelihood of undergoing reoperative coronary artery bypass graft surgery (CABG) is important for older patients who are considering first-time CABG. Trends in the reoperative CABG for these patients are unknown. Methods and Results We used the Medicare fee-for-service inpatient claims data of adults undergoing isolated first-time CABG between 1998 and 2017. The primary outcome was time to first reoperative CABG within 5 years of discharge from the index surgery, treating death as a competing risk. We fitted a Cox regression to model the likelihood of reoperative CABG as a function of patient baseline characteristics. There were 1 666 875 unique patients undergoing first-time isolated CABG and surviving to hospital discharge. The median (interquartile range) age of patients did not change significantly over time (from 74 [69-78] in 1998 to 73 [69-78] in 2017); the proportion of women decreased from 34.8% to 26.1%. The 5-year rate of reoperative CABG declined from 0.77% (95% CI, 0.72%-0.82%) in 1998 to 0.23% (95% CI, 0.19%-0.28%) in 2013. The annual proportional decline in the 5-year rate of reoperative CABG overall was 6.6% (95% CI, 6.0%-7.1%) nationwide, which did not differ across subgroups, except the non-white non-black race group that had an annual decline of 8.5% (95% CI, 6.2%-10.7%). Conclusions Over a recent 20-year period, the Medicare fee-for-service patients experienced a significant decline in the rate of reoperative CABG. In this cohort of older adults, the rate of declining differed across demographic subgroups.
对于考虑首次冠状动脉旁路移植术（CABG）的老年患者来说，再次接受 CABG 的可能性非常重要。目前尚不清楚这些患者再次接受 CABG 的趋势。
我们使用了 1998 年至 2017 年期间接受单独首次 CABG 的成年人的 Medicare 按服务项目付费住院索赔数据。主要结果是在索引手术后 5 年内首次再次 CABG 的时间，将死亡视为竞争风险。我们拟合了 Cox 回归模型，以患者基线特征为函数来预测再次 CABG 的可能性。有 1666875 名独特的患者接受了首次单独的 CABG 并在出院后存活下来。患者的中位（四分位距）年龄在整个研究期间没有明显变化（从 1998 年的 74 [69-78]到 2017 年的 73 [69-78]）；女性的比例从 34.8%下降到 26.1%。5 年内再次 CABG 的发生率从 1998 年的 0.77%（95% CI，0.72%-0.82%）下降到 2013 年的 0.23%（95% CI，0.19%-0.28%）。全国范围内，5 年内再次 CABG 发生率的年比例下降总体为 6.6%（95% CI，6.0%-7.1%），在各亚组之间没有差异，除了非白非黑种族组的年下降率为 8.5%（95% CI，6.2%-10.7%）。
在最近的 20 年中，医疗保险按服务项目付费患者再次接受 CABG 的比例显著下降。在这个老年患者队列中，不同人口统计学亚组之间的下降率不同。
