Complications of Coronary Artery Bypass Surgery
Modern MedicineIn this day and age of modern medicine it seems as though people don't have to be concerned about getting ill. We now have a wide variety of therapies and replacement parts available, some of them with very good results: eg Alonzo Mourning. Although the real statistics on modern cancer therapy aren't quite as impressive, few cancers escape the slash and burn approach. We have many replacement joint parts including knees. Not too many of those however, continue their NBA basketball career. I can still remember, when as part of my medical internship at IUMC hospitals, I spent three months at St. Lukes hospital in Denver. While I was there, Dr. John Grow, performed the first coronary artery surgery to reestablish blood flow at St. Lukes. That year was 1970. A lot has happened since then and today coronary artery bypass surgery is a common and accepted procedure. But, as usual, there is no free lunch. Before you eat that next super-sized double bacon cheeseburger at your local golden arches, check out some of these complications.
Some Current Studies
From Wikipedia
Link: <to">http://www.en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#complications>to read original article
CABG associated
Postperfusion syndrome (pumphead), a transient neurocognitive impairment associated with cardiopulmonary bypass. Some research shows the incidence is initially decreased by off-pump coronary artery bypass, but with no difference beyond three months after surgery. A neurocognitive decline over time has been demonstrated in people with coronary artery disease regardless of treatment (OPCAB, conventional CABG or medical management).
* Nonunion of the sternum; internal thoracic artery harvesting devascularizes the sternum increasing risk.
* Myocardial infarction due to embolism, hypoperfusion, or graft failure. * Late graft stenosis, particularly of saphenous vein grafts due to atherosclerosis causing recurrent angina or myocardial infarction.
* Acute renal failure due to embolism or hypoperfusion. * Stroke, secondary to embolism or hypoperfusion.
General surgical
* Infection at incision sites or sepsis.
* Deep vein thrombosis (DVT)
* Anesthetic complications such as malignant hyperthermia.
* Keloid scarring * Chronic pain at incision sites
* Chronic stress related illnesses
* Death
from the British Medical Journal
Link: <to">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1419012>to read original article
A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports.
from Jackson Memorial Hospital
Link: <to">http://www.circ.ahajournals.org/cgi/content/abstract/48/1S3/III-120>to read original article
Complications of Coronary Bypass SurgeryHOOSHANG BOLOOKI M.D.1; LEONARD S. SOMMER M.D.1; ALI GHAHRAMANI M.D.1; DAMAIO CUNHA M.D.1; Michael Gill B.S.1 1 From the Division of Thoracic and Cardiovascular Surgery and Cardiovascular Laboratories, Jackson Memorial Hospital-University of Miami School of Medicine, Miami, Florida.
In the past three years, among 170 patients undergoing aortocoronary bypass surgery, 11 (6%) developed acute myocardial infarction within 24 hours after surgery. An additional four patients (2%) developed myocardial infarction within three months after discharge. Clinically, acute myocardial infarction was suspected because of sudden, transient hypotension associated with dysrhythmia, angina, or cardiac arrest which responded to conventional therapy. Elevation of serum enzymes with acute ECG changes was also observed. Three of the 15 patients developing myocardial infarction died. In 12 patients cardiac catheterization studies were performed within two to ten weeks after the incident. Eleven of the 20 grafts were found occluded, and progression of coronary occlusive disease was seen in five. There was a marked decrease in left ventricular function, contractility, and compliance in all patients with left ventricular aneurysm formation or dyskinesia. Eight of these patients were asymptomatic. The results indicate that after coronary surgery a combination of sudden arrhythmia and transient hypotension is diagnostic of graft closure or development of acute myocardial infarction. Also, in spite of depressed cardiac function, most surviving patients remain angina free.
Death Coma and Stroke
Back when I was a radiology resident, we would obtain informed consent from any patient scheduled for a procedure. Seriously, the first three words on the informed consent form were death, coma and stroke. It seemed as if most were not too overly concerned. I was very fortunate in that none of the procedures I was involved in resulted in any serious complications. I did however witness some other less than optimal outcomes. In reviewing the complications of coronary artery bypass, all three, death, coma and stroke, were there in significant proportion. If the statistical mortality or significant morbidity from any given procedure is even just 5% but that complication happens to you, then for you, that percentage is now 100%! There is nothing better than "original equipment."
another look at the numbers
seeing through the statistical haze
Estimates for the number of coronary artery bypass procedures are approximately 500,000/year for the United States to approximately 800,000/year worldwide. If we take an average mortality of even just 2%, that would translate into 10,000 deaths/year for the United States alone and 16,000 deaths/year for the world.
Statewide Figures for CABG Surgeryfor Pennsylvania
Link: <to">http://www.phc4.org/reports/cabg/00/statewide.htm>to read original article
* in-hospital mortality rate 2.4%
* 30-Day mortality rate 2.7%
* 7-Day readmission rate 6.2%
* 30-Day readmission rate 14.5%
* Average post-sugical length of stay 5.8 days
* Average hospital charge $59,939
That seems to me to be an awful lot of people for a procedure that does not address the real problem that causes coronary disease in the first place -poor eating habits.
conclusion
Looking at the combined morbidity and mortality for this procedure I think I would much rather just quit eating meat and sugar, eat fewer times per day to get my glucagon going and take my chances with my original equipment.
posted by John Mericle M.D. D.A.B.R. @ 5:22 PM
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