The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
The George Washington University Hospital, Department of Surgery, Washington, DC, USA.
Alcohol. 2024 Nov;120:51-57. doi: 10.1016/j.alcohol.2024.03.002. Epub 2024 Mar 5.
Alcohol abuse (AA) has s high prevalence, affecting 10 to 15 million Americans. While AA was demonstrated to negatively impact cardiovascular health, limited evidence from existing studies presents conflicting findings regarding the effects of AA on coronary artery bypass grafting (CABG) outcomes. This study aimed to compare the in-hospital outcomes after CABG between AA and non-AA patients.
Patients who underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Exclusion criteria included age<18 years and concomitant procedures. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between AA and non-AA patients. In-hospital outcomes after CABG were examined.
There were 5694 (3.39%) AA patients who underwent CABG. After matching, 17,315 from 162,488 non-AA patients were matched to all AA patients. AA and non-AA patients had comparable mortality (1.64% vs 1.55%, p = 0.67) and MACE (2.46% vs 2.56%, p = 0.73). However, AA patients had higher cardiogenic shock (8.31% vs 7.43%, p = 0.03), mechanical ventilation (11.51% vs 7.96%, p < 0.01), hemorrhage/hematoma (57.49% vs 54.75%, p < 0.01), superficial (0.99% vs 0.61%, p < 0.01) and deep wound complications (0.37% vs 0.18%, p = 0.02), reopen surgery for bleeding control (0.92% vs 0.63%, p = 0.03), transfer out (21.00% vs 16.38%, p < 0.01), longer time from admission to operation (p < 0.01), longer length of stay (p < 0.01), and higher hospital charge (p < 0.01).
While AA was not found to be linked with in-hospital mortality or MACE after CABG, it was independently associated with postoperative complications. These findings could enhance preoperative risk stratification for AA patients and inform postoperative management following CABG.
酗酒（AA）的患病率很高，影响了 1000 万至 1500 万美国人。虽然已经证明 AA 会对心血管健康产生负面影响，但现有研究的有限证据对 AA 对冠状动脉旁路移植术（CABG）结果的影响提出了相互矛盾的发现。本研究旨在比较 CABG 后 AA 和非 AA 患者的住院结局。
从 2015 年第四季度至 2020 年，在国家住院患者样本中确定了接受 CABG 的患者。排除标准包括年龄<18 岁和合并手术。使用 1：3 倾向评分匹配来解决 AA 和非 AA 患者在人口统计学、社会经济地位、主要付款人状态、医院特征、合并症和转移/入院状态方面的差异。检查了 CABG 后的住院结局。
共有 5694 名（3.39%）接受 CABG 的 AA 患者。匹配后，从 162488 名非 AA 患者中匹配了 17315 名患者与所有 AA 患者匹配。AA 和非 AA 患者的死亡率（1.64%对 1.55%，p=0.67）和 MACE（2.46%对 2.56%，p=0.73）相当。然而，AA 患者的心源性休克发生率更高（8.31%对 7.43%，p=0.03）、机械通气（11.51%对 7.96%，p<0.01）、出血/血肿（57.49%对 54.75%，p<0.01）、浅表（0.99%对 0.61%，p<0.01）和深部伤口并发症（0.37%对 0.18%，p=0.02）、为控制出血而再次手术（0.92%对 0.63%，p=0.03）、转出（21.00%对 16.38%，p<0.01）、从入院到手术的时间更长（p<0.01）、住院时间更长（p<0.01）和医院费用更高（p<0.01）。
虽然 CABG 后 AA 与住院死亡率或 MACE 无关，但与术后并发症独立相关。这些发现可以增强 AA 患者的术前风险分层，并为 CABG 后提供术后管理信息。
