Nonelective coronary artery bypass graft outcomes are adversely impacted by Coronavirus disease 2019 infection, but not altered processes of care: A National COVID Cohort Collaborative and National Surgery Quality Improvement Program analysis
Grimsley EA., Torikashvili JV., Janjua HM., Read MD., Kothari AN., Verhagen NB., Pietrobon R., Kuo PC., Rogers MP., Wilcox AB., Lee AM., Graves A., Anzalone A., Manna A., Saha A., Olex A., Zhou A., Williams AE., Southerland A., Girvin AT., Walden A., Sharathkumar AA., Amor B., Bates B., Hendricks B., Patel B., Alexander C., Bramante C., Ward-Caviness C., Madlock-Brown C., Suver C., Chute C., Dillon C., Wu C., Schmitt C., Takemoto C., Housman D., Gabriel D., Eichmann DA., Mazzotti D., Brown D., Boudreau E., Hill E., Zampino E., Marti EC., Pfaff ER., French E., Koraishy FM., Mariona F., Prior F., Sokos G., Martin G., Lehmann H., Spratt H., Mehta H., Liu H., Sidky H., Hayanga JWA., Pincavitch J., Clark J., Harper JR., Islam J., Ge J., Gagnier J., Saltz JH., Saltz J., Loomba J., Buse J., Mathew J., Rutter JL., McMurry JA., Guinney J., Starren J., Crowley K., Bradwell KR., Walters KM., Wilkins K., Gersing KR., Cato KD., Murray K., Kostka K., Northington L., Pyles LA., Misquitta L., Cottrell L., Portilla L., Deacy M., Bissell MM., Clark M., Emmett M., Saltz MM., Palchuk MB., Haendel MA., Adams M., Temple-O'Connor M., Kurilla MG., Morris M., Qureshi N., Safdar N., Garbarini N.
Objective: The effects of Coronavirus disease 2019 (COVID-19) infection and altered processes of care on nonelective coronary artery bypass grafting (CABG) outcomes remain unknown. We hypothesized that patients with COVID-19 infection would have longer hospital lengths of stay and greater mortality compared with COVID-negative patients, but that these outcomes would not differ between COVID-negative and pre-COVID controls. Methods: The National COVID Cohort Collaborative 2020-2022 was queried for adult patients undergoing CABG. Patients were divided into COVID-negative, COVID-active, and COVID-convalescent groups. Pre-COVID control patients were drawn from the National Surgical Quality Improvement Program database. Adjusted analysis of the 3 COVID groups was performed via generalized linear models. Results: A total of 17,293 patients underwent nonelective CABG, including 16,252 COVID-negative, 127 COVID-active, 367 COVID-convalescent, and 2254 pre-COVID patients. Compared to pre-COVID patients, COVID-negative patients had no difference in mortality, whereas COVID-active patients experienced increased mortality. Mortality and pneumonia were higher in COVID-active patients compared to COVID-negative and COVID-convalescent patients. Adjusted analysis demonstrated that COVID-active patients had higher in-hospital mortality, 30- and 90-day mortality, and pneumonia compared to COVID-negative patients. COVID-convalescent patients had a shorter length of stay but a higher rate of renal impairment. Conclusions: Traditional care processes were altered during the COVID-19 pandemic. Our data show that nonelective CABG in patients with active COVID-19 is associated with significantly increased rates of mortality and pneumonia. The equivalent mortality in COVID-negative and pre-COVID patients suggests that pandemic-associated changes in processes of care did not impact CABG outcomes. Additional research into optimal timing of CABG after COVID infection is warranted.