Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery

Background-Although dialysis patients are undergoing CABG with increasing f requency, large studies specifically comparing patient characteristics and procedure-related risks in this population have not been performed. Methods and Results-We conducted a regional prospective cohort study of 15 500 consecutive patients undergoing CABG in northern New England from 1992 to 1997. We used multiple logistic regression analysis to examine associati ons between preoperative dialysis-dependent renal failure and postoperative events and to adjust for potentially confounding variables. The 279 dialys is-dependent renal failure patients (1.8%) were 4.4 times more likely to ex perience in-hospital mortality than were other CABG patients (12.2% versus 3.0%, respectively; P<0.001). Dialysis-dependent renal failure patients wer e older and had more comorbidities and more severe cardiac disease than did other CABG patients. After adjusting for these factors in multivariate ana lysis, however, dialysis-dependent renal failure patients remained 3.1 time s more likely to die after CABG (adjusted odds ratio [OR] 3.1, 95% CI 2.1 t o 4.7; P<0.001). Dialysis-dependent renal failure patients compared with ot her CABG patients also had a substantially increased risk of postoperative mediastinitis (3.6% versus 1.2%, respectively; adjusted OR 2.4, 95% CI 1.2 to 4.7; P=0.011) and postoperative stroke (4.3% versus 1.7%, respectively; adjusted OR 2.1, 95% CI 1.1 to 3.9; P=0.016), even after controlling for po tentially confounding variables. Risks of reexploration for bleeding were s imilar for patients with and without dialysis-dependent renal failure. Conclusions-Preoperative dialysis-dependent renal failure is a strong indep endent risk factor for in-hospital mortality and mediastinitis after CABG.