40. Urgent/Emergent CABG Outcomes are Adversely Impacted by COVID Infection, But Not Altered Processes of Care: An N3C and NSQIP Analysis
Presented During: Complex Issues in Coronary Surgery*
*Rakesh Arora
Invited Discussant
Cleveland University Hospitals
Cleveland, OH
United States - Contact Me
Cleveland University Hospitals
Cleveland, OH
United States - Contact Me
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.
Saturday, May 6, 2023: 10:45 AM - 11:00 AM
15 Minutes
Los Angeles Convention Center
Room: 515A
Abstract
Objective: The differential effects of COVID-19 active viral infection, viral convalescence, and altered care processes on emergency CABG (eCABG) outcomes have not been studied. We sought to evaluate whether the altered processes of care due to the pandemic's burden on healthcare institutions negatively impacted eCABG outcomes.
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.
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.
Presentation Duration
7 minute presentation; 7 minute discussion