3RD CORONARY-ARTERY BYPASS OPERATIONS - RISKS AND COSTS

Background. Third coronary artery bypass operations are technically di fficult and are associated with increased risk. Methods. We reviewed t he cases of 469 patients who had undergone a third isolated coronary a rtery bypass operation and used univariate and multivariate testing to examine the effect of preoperative and operative variables on outcome and costs. Results. The in-hospital mortality was 7.0% (33 patients). Advanced age and severe symptoms were found to increase risk (both p < 0.05): the mortality was 14% (n = 74) in patients 70 years old or ol der who had severe symptoms. However, the overall mortality Sor 1993 t hrough 1995 was 4.3% (5/117) and only one death (1.3%) occurred among the 79 patients who were less than 70 years old. The late survival rat e was 94%, 84%, and 66% at 1, 5, and 10 postoperative years, respectiv ely, and predictors of decreased late survival were advanced age, abno rmal left ventricular function, and diabetes (all p < 0.05). Again, ag e of 70 years or more was a predictor of a poor outcome. Only 52% of p atients in that subgroup (including both early and late mortality) wer e alive 5 years after operation. Analysis of direct hospital costs sho wed that the mean costs of third coronary artery bypass operations wer e 21% higher than the mean costs of primary operations but that the el evation in the mean costs for third operations was related to very hig h costs in 4 patients. Sex was found to influence the cost of both pri mary and third operations (increased cost for women). Conclusions. Unf avorable outcomes after third coronary artery bypass operations have b een associated with preoperatively definable variables, particularly a ge of 70 years or more. The in-hospital mortality in patients younger than 70 was low, and long-term survival in this group has been favorab le. The increased hospital costs associated with third operations are related to high costs in only a few patients and have been unpredictab le. (C) 1997 by The Society of Thoracic Surgeons.