SIMULTANEOUS CORONARY-ARTERY BYPASS-GRAFTING AND ABDOMINAL ANEURYSM REPAIR DECREASES STAY AND COSTS

Background. Patients with large (greater than or equal to 5.0 cm) abdo minal aortic aneurysms (AAA) frequently have marked associated coronar y artery disease. We hypothesized that a single operation for coronary artery bypass grafting (CABG)/AAA would provide equivalent, if not im proved, patient care while decreasing postoperative length of stay and hospital costs compared with staged procedures. Methods. Eleven patie nts to date have undergone a combined procedure at our institution. Te n underwent CABG followed by AAA repair, whereas one patient received an aortic valve replacement before aneurysm repair. We performed a ret rospective analysis comparing the postoperative length of stay and hos pital costs for this single procedure to a combined cohort of 20 rando mly selected patients who either received AAA repair (n = 10) or stand ard CABG (n = 10) during the same time period. Results. No operative m ortality has been reported. There were no episodes of neurologic defic it or cardiac complication after these procedures. The postoperative l ength of stay was significantly decreased for the CABG/ AAA group comp ared with the combined postoperative length of stay for the AAA plus C ABG group (7.44 +/- 0.88 days versus 14.10 +/- 2.00; p = 0.012). Total hospital costs were also significantly decreased for the CABG/AAA gro up compared with total hospital costs for the AAA plus CABG group ($22 ,941 +/- $1,933 versus $34,076 +/- $2,534; p = 0.003). Conclusions, A single operation for coronary revascularization and AAA repair is safe and effective. Simultaneous CABG and AAA repair substantially decreas es postoperative length of stay and hospital costs while avoiding poss ible interim aneurysm rupture and repeat anesthesia. (Ann Thorac Surg 1998;66:1273-6) (C) 1998 by The Society of Thoracic Surgeons