Rate of Major Anesthetic-Related Outcomes in the Intraoperative and Immediate Postoperative Period After Cardiac Surgery

Published:December 18, 2015DOI:


      To examine anesthesia-centered outcomes in a large cohort of patients undergoing coronary artery bypass grafting (CABG) or valvular heart surgery.


      A retrospective study with univariate and multivariate logistic regression to identify independent predictors for mortality.


      Diverse setting including university, small, medium, and large community hospitals.


      All patients undergoing CABG or valve surgery in the National Anesthesia Clinical Outcomes Registry (NACOR) from the Anesthesia Quality Institute.



      Measurements and Main Results

      Common anesthesia-centered outcomes including arrhythmia, cardiac arrest, death, hemodynamic instability, hypotension, inadequate pain control, nausea/vomiting, seizure, stroke, reintubation and transfusion were reported. All outcomes, consistent with NACOR data entry, were defined as occurring intraoperatively or during phase I or II recovery in the PACU. Death occurred in 0.15% of CABGs and 0.23% of valve surgeries. Age less than 18, American Society of Anesthesiologists physical status (ASA PS) classification of 5, and mean case duration greater than 6 hours were associated with increased mortality (p<0.05). The presence of a board-certified anesthesiologist was associated with decreased odds for mortality.


      Death was a rare outcome in this cohort, reflecting the infrequent occurrence of intraoperative or immediate postoperative death. The presence of a board-certified anesthesiologist represented a modifiable risk factor for reducing mortality risk.

      Key Word

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        • Epstein A.J.
        • Polsky D.
        • Yang F.
        • et al.
        Coronary revascularization trends in the United States, 2001-2008.
        JAMA. 2011; 305: 1769-1776
        • Wilson C.T.
        • Fisher E.S.
        • Welch H.G.
        • et al.
        U.S. trends in CABG hospital volume: The effect of adding cardiac surgery programs.
        Health Aff (Millwood). 2007; 26: 162-168
        • Lloyd-Jones D.
        • Adams R.J.
        • Brown T.M.
        • et al.
        Heart disease and stroke statistics—2010 update: A report from the American Heart Association.
        Circulation. 2010; 121: e46-e215
        • Farkouh M.E.
        • Domanski M.
        • Sleeper L.A.
        • et al.
        Strategies for multivessel revascularization in patients with diabetes.
        N Engl J Med. 2012; 367: 2375-2384
        • Hannan E.L.
        • Wu C.
        • Walford G.
        • et al.
        Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
        N Engl J Med. 2008; 358: 331-341
        • King S.B.
        Is surgery preferred for the diabetic with multivessel disease? Surgery is preferred for the diabetic with multivessel disease.
        Circulation. 2005; 112: 1500-1507
        • Serruys P.W.
        • Morice M.C.
        • Kappetein A.P.
        • et al.
        Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
        N Engl J Med. 2009; 360: 961-972
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • et al.
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: e57-185
        • Cameron A.
        • Davis K.B.
        • Green G.
        • et al.
        Coronary bypass surgery with internal-thoracic-artery grafts—effects on survival over a 15-year period.
        N Engl J Med. 1996; 334: 216-219
        • Myers W.O.
        • Blackstone E.H.
        • Davis K.
        • et al.
        CASS Registry long term surgical survival. Coronary Artery Surgery Study.
        J Am Coll Cardiol. 1999; 33: 488-498
        • Shahian D.M.
        • O’Brien S.M.
        • Sheng S.
        • et al.
        Predictors of long-term survival after coronary artery bypass grafting surgery: Results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study).
        Circulation. 2012; 125: 1491-1500
        • Wu C.
        • Camacho F.T.
        • Wechsler A.S.
        • et al.
        Risk score for predicting long-term mortality after coronary artery bypass graft surgery.
        Circulation. 2012; 125: 2423-2430
        • Glance L.G.
        • Kellermann A.L.
        • Hannan E.L.
        • et al.
        The impact of anesthesiologists on coronary artery bypass graft surgery outcomes.
        Anesth Analg. 2015; 120: 526-533
        • Carson J.L.
        • Grossman B.J.
        • Kleinman S.
        • et al.
        Red blood cell transfusion: A clinical practice guideline from the AABB*.
        Ann Intern Med. 2012; 157: 49-58
        • Birkmeyer J.D.
        • Siewers A.E.
        • Finlayson E.V.
        • et al.
        Hospital volume and surgical mortality in the United States.
        N Engl J Med. 2002; 346: 1128-1137
        • Myers W.O.
        • Davis K.
        • Foster E.D.
        • et al.
        Surgical survival in the Coronary Artery Surgery Study (CASS) registry.
        Ann Thorac Surg. 1985; 40: 245-260
        • Nallamothu B.K.
        • Saint S.
        • Ramsey S.D.
        • et al.
        The role of hospital volume in coronary artery bypass grafting: Is more always better?.
        J Am Coll Cardiol. 2001; 38: 1923-1930
        • Peterson E.D.
        • Coombs L.P.
        • DeLong E.R.
        • et al.
        Procedural volume as a marker of quality for CABG surgery.
        JAMA. 2004; 291: 195-201
      1. Anesthesia Quality Institute. PUF (Participant User File). Available at: Accessed January 28, 2015

        • Twersky R.S.
        • Philip B.K.
        Handbook of Ambulatory Anesthesia.
        2nd ed. Springer, New York, NY2008: 355
        • Alexander J.H.
        • Hafley G.
        • Harrington R.A.
        • et al.
        Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: A randomized controlled trial.
        JAMA. 2005; 294: 2446-2454
        • Brener S.J.
        • Lytle B.W.
        • Schneider J.P.
        • et al.
        Association between CK-MB elevation after percutaneous or surgical revascularization and three-year mortality.
        J Am Coll Cardiol. 2002; 40: 1961-1967
        • Bukkapatnam R.N.
        • Yeo K.K.
        • Li Z.
        • et al.
        Operative mortality in women and men undergoing coronary artery bypass grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program).
        Am J Cardiol. 2010; 105: 339-342
        • Cram P.
        • Rosenthal G.E.
        • Vaughan-Sarrazin M.S.
        Cardiac revascularization in specialty and general hospitals.
        N Engl J Med. 2005; 352: 1454-1462
        • Engoren M.C.
        • Habib R.H.
        • Zacharias A.
        • et al.
        The association of elevated creatine kinase-myocardial band on mortality after coronary artery bypass grafting surgery is time and magnitude limited.
        Eur J Cardiothorac Surg. 2005; 28: 114-119
        • Hannan E.L.
        • Racz M.J.
        • Walford G.
        • et al.
        Long-term outcomes of coronary-artery bypass grafting versus stent implantation.
        N Engl J Med. 2005; 352: 2174-2183
        • Hannan E.L.
        • Wu C.
        • Bennett E.V.
        • et al.
        Risk stratification of in-hospital mortality for coronary artery bypass graft surgery.
        J Am Coll Cardiol. 2006; 47: 661-668
        • Alexander J.H.
        • Emery Jr, R.W.
        • Carrier M.
        • et al.
        Efficacy and safety of pyridoxal 5’-phosphate (MC-1) in high-risk patients undergoing coronary artery bypass graft surgery: The MEND-CABG II randomized clinical trial.
        JAMA. 2008; 299: 1777-1787
        • LaPar D.J.
        • Filardo G.
        • Crosby I.K.
        • et al.
        The challenge of achieving 1% operative mortality for coronary artery bypass grafting: A multi-institution Society of Thoracic Surgeons Database analysis.
        J Thorac Cardiovasc Surg. 2014; 148: 2686-2696
        • Nallamothu B.K.
        • Saint S.
        • Hofer T.P.
        • et al.
        Impact of patient risk on the hospital volume-outcome relationship in coronary artery bypass grafting.
        Arch Intern Med. 2005; 165: 333-337
        • Smith P.K.
        • Shernan S.K.
        • Chen J.C.
        • et al.
        Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: Combined results from the PRIMO-CABG I and II trials.
        J Thorac Cardiovasc Surg. 2011; 142: 89-98
        • Tardif J.C.
        • Carrier M.
        • Kandzari D.E.
        • et al.
        Effects of pyridoxal-5’-phosphate (MC-1) in patients undergoing high-risk coronary artery bypass surgery: Results of the MEND-CABG randomized study.
        J Thorac Cardiovasc Surg. 2007; 133: 1604-1611
        • Verrier E.D.
        • Shernan S.K.
        • Taylor K.M.
        • et al.
        Terminal complement blockade with pexelizumab during coronary artery bypass graft surgery requiring cardiopulmonary bypass: A randomized trial.
        JAMA. 2004; 291: 2319-2327
        • Yap C.H.
        • Sposato L.
        • Akowuah E.
        • et al.
        Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality.
        Ann Thorac Surg. 2009; 87: 1386-1391
        • Boden W.E.
        • O’Rourke R.A.
        • Teo K.K.
        • et al.
        Optimal medical therapy with or without PCI for stable coronary disease.
        N Engl J Med. 2007; 356: 1503-1516
        • Guru V.
        • Tu J.V.
        • Etchells E.
        • et al.
        Relationship between preventability of death after coronary artery bypass graft surgery and all-cause risk-adjusted mortality rates.
        Circulation. 2008; 117: 2969-2976
        • Hajjar L.A.
        • Vincent J.L.
        • Galas F.R.
        • et al.
        Transfusion requirements after cardiac surgery:The TRACS randomized controlled trial.
        JAMA. 2010; 304: 1559-1567
        • Bennett-Guerrero E.
        • Zhao Y.
        • O’Brien S.M.
        • et al.
        Variation in use of blood transfusion in coronary artery bypass graft surgery.
        JAMA. 2010; 304: 1568-1575
        • Ferraris V.A.
        • Ferraris S.P.
        • Saha S.P.
        • et al.
        Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline.
        Ann Thorac Surg. 2007; 83: S27-S86
        • Pine M.
        • Holt K.D.
        • Lou Y.B.
        Surgical mortality and type of anesthesia provider.
        AANA J. 2003; 71: 109-116
        • Silber J.H.
        • Kennedy S.K.
        • Even-Shoshan O.
        • et al.
        Anesthesiologist direction and patient outcomes.
        Anesthesiology. 2000; 93: 152-163
        • Raval M.V.
        • Wang X.
        • Cohen M.E.
        • et al.
        The influence of resident involvement on surgical outcomes.
        J Am Coll Surg. 2011; 212: 889-898