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Outcomes/Effectiveness Research

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Outcomes of repeat coronary bypass surgery are comparable to outcomes of initial bypass surgery

The number of people who underwent repeat coronary artery bypass grafting (CABG) in the United States more than quadrupled from 1.9 percent of all CABG operations in 1980 to 8.4 percent in 1999. Individuals who undergo repeat CABG improve their health and functioning as much as those who undergo a first CABG, according to the findings of a study supported in part by the Agency for Healthcare Research and Quality (HS11282).

Repeat CABG was as effective as a first CABG in relieving angina (crushing chest pain), improving function, and enhancing quality of life. This information should be useful in counseling patients about the benefits of reoperation and in justifying the use of repeat surgery, notes David M. Safley, M.D., of the University of Missouri, Kansas City.

Dr. Safley and his colleagues examined the 12-month outcomes of 690 patients who had CABG surgery at one hospital between February 1999 and August 2000. Of these, 62 (9 percent) had undergone a previous CABG. Patients completed questionnaires at baseline and 1 year after CABG (for survivors) to assess their angina frequency, physical limitations, and quality of life. Scales ranged from 0 to 100, with higher scores indicating better function, fewer symptoms, and higher quality of life.

Overall incidence of complications was not significantly different for repeat compared with first CABG, although in-hospital mortality was substantially higher for repeat CABG patients (9.7 vs. 1.8 percent) who had more coexisting illnesses and more severe symptoms than first-time CABG patients. An equal rate of first-time and repeat CABG patients died within a year of discharge from the hospital. One year after CABG, repeat CABG patients had similar physical limitation scores as first-time CABG patients (86 vs. 91) and similar quality of life scores (86 vs. 91) but slightly more residual angina (92 vs. 96). Given their worse health status at the time of their procedure, changes in angina scores for repeat CABG patients were equal to those of patients who underwent their first CABG.

See "Comparison of quality of life after repeat versus initial coronary artery bypass grafting," by Dr. Safley, John A. House, M.S., A. Michael Borkon, M.D., and John A. Spertus, M.D., M.P.H., in the American Journal of Cardiology 94, pp. 494-497, 2004.

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