Coronary artery bypass surgery on small patients

Little research exists on the outcome of smaller patients who undergo coron ary artery by-pass graft surgery. The purpose of this study was to evaluate the outcomes of cardiac surgery in smaller patients (males with body surfa ce area of 1.6 square meters or less, and women with 1.5 meters or less). A consecutive series of 4,358 patients undergoing bypass surgery was evaluat ed. Of these, 246 (5.6%) mere classified as small patients. Smaller patient s mere more likely to be women, older and of Asian ethnicity. They mere les s likely to have undergone a prior cardiac surgery. Smaller patients were l ess likely to receive an arterial conduit (74% versus 99%; p < 0.00001). Ra tes of post-surgery complications differed between small and normal size pa tients, with smaller patients more likely to require prolonged ventilator s upport (p < 0.05), more likely to have acute renal failure (p < 0.0001), mo re transfusions and re-operation for bleeding (p < 0.05), higher death rate (5.7% versus 2.6%; p < 0.01) and longer length of hospital stay (11.4 vers us 8.3 days; p < 0.00001). In multivariate analyses evaluating factors rela ted to death, emergent surgery, poor ejection fraction and older patient ag e mere independently related to mortality. Small body surface area was not an independent predictor. The results of this study indicate that smaller p atients do have poorer outcomes associated with coronary artery bypass surg ery. However, 90% of the smaller patients did have an event-free surgery. S urgeons may need to monitor these patients more closely and anticipate the increased risk and cost that is associated with this group.