Li Renxi, Prastein Deyanira J
The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America.
Department of Surgery, The George Washington University Hospital, Washington, D.C., United States of America.
Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240202. doi: 10.21470/1678-9741-2024-0202.
Previous studies found that patients with a history of cancer either have similar outcomes or face an increased risk of early morbidity following cardiac surgery. However, the applicability of these findings to clinical practice may be constrained by the heterogeneity of cancer patients. To refine our understanding, this study focuses specifically on the in-hospital outcomes of patients with non-metastatic malignant solid tumors (NMST) undergoing coronary artery bypass grafting (CABG).
Patients who underwent CABG were identified in National/Nationwide Inpatient Sample from Q4 2015-2020. Exclusion criteria included age < 18 years, concomitant procedures, and other malignancies. A 1:3 propensity-score matching was employed to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and admission status between patients with and without NMST. In-hospital outcomes after CABG were evaluated.
There were 2,139 patients with NMST who underwent CABG and who were matched to 6,580 out of 164,351 patients without NMST. Patients with and without NMST had comparable mortality (2.25% vs. 2.16%, P=0.80). However, NMST patients have a higher risk of hemorrhage/hematoma (63.48% vs. 58.27%, P<0.01) and a higher rate of transfer out (28.75% vs. 25.36%, P<0.01). In addition, patients with NMST had longer time from admission to operation (P<0.01), a longer length of stay (P<0.01), and higher hospital charges (P<0.01).
Patients with NMST have comparable short-term outcomes after CABG, except for a higher risk of postoperative bleeding. Thus, CABG could be performed safely for NMST patients, despite long-term prognosis of these patients may require further investigation.
先前的研究发现，有癌症病史的患者在心脏手术后的预后要么相似，要么面临早期发病风险增加的情况。然而，这些研究结果在临床实践中的适用性可能受到癌症患者异质性的限制。为了深化我们的理解，本研究特别关注接受冠状动脉旁路移植术（CABG）的非转移性恶性实体瘤（NMST）患者的院内结局。
在2015年第四季度至2020年的国家/全国住院患者样本中识别接受CABG的患者。排除标准包括年龄<18岁、同期手术以及其他恶性肿瘤。采用1:3倾向评分匹配来解决有和没有NMST的患者在人口统计学、社会经济地位、主要支付者状态、医院特征、合并症和入院状态方面的差异。评估CABG后的院内结局。
有2139例接受CABG的NMST患者，与164351例无NMST患者中的6580例进行了匹配。有和没有NMST的患者死亡率相当（2.25%对2.16%，P = 0.80）。然而，NMST患者发生出血/血肿的风险更高（63.48%对58.27%，P<0.01），转出率更高（28.75%对25.36%，P<0.01）。此外，NMST患者从入院到手术的时间更长（P<0.01），住院时间更长（P<0.01），医院费用更高（P<0.01）。
NMST患者在CABG后的短期结局相当，但术后出血风险更高。因此，尽管这些患者的长期预后可能需要进一步研究，但CABG对NMST患者可以安全进行。
