40. Urgent/Emergent CABG Outcomes are Adversely Impacted by COVID Infection, But Not Altered Processes of Care: An N3C and NSQIP Analysis
Cleveland University Hospitals
Cleveland, OH
United States - Contact Me
Dr. Arora pursued his Medical Doctorate from the University of Toronto in 1996. His commitment to his field led him to Dalhousie University in Halifax, Nova Scotia, where he completed his Cardiac Surgery Residency. It was during this time that he demonstrated his exceptional dedication by also completing a Doctorate of Philosophy in the Department of Anatomy/Neurobiology in the field of neurocardiology. His commitment to learning and pushing the boundaries of his field continued with two further years of training at the University of Calgary, in Calgary, Alberta, where he became the first Cardiac Surgeon in Canada to also complete a fellowship in Critical Care Medicine in 2006.
In 2022, Dr. Arora joined the Division of Cardiac Surgery in the Harrington Heart Vascular Institute (HHVI) at the University Hospitals as the Director of Perioperative and Cardiac Critical Care. He is presently a clinical professor at Case Western Reserve University, holds Dr. Alan H. Markowitz, MD, endowed Chair for Cardiac Surgery at University Hospitals. He is also the director of clinical research for the cardiac surgery division with the Harrington HV. His personal research interests have concentrated on enhancing the recovery and care of critically ill cardiac patients. He has a specific focus on delirium and frailty in older adults undergoing cardiovascular surgery. He has received funding from the CIHR, HSFC and the Canadian Frailty Network. Dr. Arora has over 290 peer-reviewed manuscripts and book chapters and is an internationally invited speaker for his team’s clinical and research endeavours.
University of South Florida
Tampa, FL
United States - Contact Me
Dr. Emily A. Grimsley graduated from the University of Maryland School of Medicine in 2019 and is in the fourth year of her general surgery residency at the University of South Florida Morsani College of Medicine. She is currently a research fellow at OneToMap Analytics laboratory at The University of South Florida, under PI Dr. Paul Kuo. Her research thus far has been focused on social determinants of health and the impact of COVID-19 on surgical outcomes.
Abstract
Methods: The National COVID Cohort Collaborative (N3C) contains clinical observation, lab, medication, and procedural data from 6.5 million COVID+ (15.9 million total) patients from 76 US centers. We queried N3C (Feb. 2020 to Aug. 2022; Concept ID 4336464) to include adult patients undergoing eCABG. Patients were divided into 3 groups according to COVID test results: negative result (C-Neg), positive result <2 weeks before CABG (C-Active), or positive result >2 weeks before CABG (C-Conv). The National Surgical Quality Improvement Program (NSQIP) database was utilized for pre-COVID controls from 2016-2018. Propensity matching was performed using inverse probability of treatment weighting based on: age, gender, comorbidity score, race, social determinants of health and COVID status. Statistical analysis was performed using standardized mean difference, t-test and Chi-square test.
Results: In N3C, 16,757 patients underwent eCABG (16,262 C-Neg, 125 C-Active, 370 C-Conv); there were 546 eCABG in NSQIP pre-COVID group (Table 1). The incidence of hospital mortality, 30-day mortality, infectious complications, and renal impairment were significantly higher in C-Active compared to C-Neg and C-Conv. Compared to pre-COVID, C-Active had increased hospital and 30-day mortality. CVA and bleeding complications did not differ. After propensity matching, length of stay (LOS) (OR 1.5), in-hospital death (OR 2.3), death within 30 and 90 days of discharge (OR 3.8, 3.8), renal impairment (OR 1.1), infectious complications (OR 3.4) and pneumonia (OR 3.8) were significantly greater in C-Active compared to C-Neg. Compared to C-Conv, C-Active had increased LOS (OR 2.7) and incidence of death (OR 6.1).
Conclusions: Traditional processes of care were altered during the COVID-19 pandemic. We conclude that eCABG in C-Active patients is associated with significantly increased mortality, LOS, and renal and infectious morbidity. Equivalent mortality in C-Neg and pre-COVID patients indicates that COVID associated changes in processes of care did not impact eCABG outcomes. Additional research into optimal timing of eCABG after COVID positivity is warranted.