0
Abstract: Poster Presentations |

CIRCADIAN RHYTHM HAS NO EFFECT ON MORTALITY IN CORONARY ARTERY BYPASS SURGERY FREE TO VIEW

Ajay K. Dhadwal, MD*; Mikhail Vaynblat, MD; Shyama Balasubramanya, MD; Murali Pagala, PhD; Nancy Schulhoff, RN; Joshua H. Burack, MD; Joseph N. Cunningham, Jr, MD
Author and Funding Information

Maimonides Medical Center, New York, NY


Chest


Chest. 2005;128(4_MeetingAbstracts):274S. doi:10.1378/chest.128.4_MeetingAbstracts.274S
Text Size: A A A
Published online

Abstract

PURPOSE:  Circadian variation affects atherosclerosis at many levels, including a circadian outcome in the treatment of myocardial infarction by angioplasty and thrombolysis.This has not been studied in the surgical patient. The circadian variation in mortality dependant on the time of surgery was examined in patients undergoing coronary artery bypass surgery (CABG).

METHODS:  A 4 year retrospective review of all CABG patients (n=3140) from 1999 to 2002 at a single institution with an accreditated training program was undertaken. The patients were divided into elective, urgent and emergency cases. The cases were subdivided according to the start time of the operation as morning (7am-2pm =AM), afternoon (2pm-8pm=AF) and night (8pm-7am =NT) and as weekday (Monday to Friday =WD) or weekend (WE) cases. The outcome was mortality within 30 days and compared for 4 different time frames: (1) AM vs. AF (2) AM vs. NT (3) AF vs. NT (4) WD vs. WE for each prioritized group. Risk factors and number of anastamoses were compared for each group. Sigma Statistical package and z-test for 2 group comparison were used for analysis. T-test was used to compare age and ejection fraction.

RESULTS:  No statistically significant difference in mortality was observed for the elective and urgent groups for each of the time periods compared (Table). The emergency cases had significantly increased deaths in the AM and NT compared to the AF (p<0.01 and p<0.05 respectively). There was no statistically significant difference with respect to age, gender, number of anastamoses performed, ejection fraction and preoperative risk factors between groups.

CONCLUSION:  The mortality for non-emergent CABG is independent of the timing of surgery. Circadian variation does not influence the outcome in cardiac surgical patients.

CLINICAL IMPLICATIONS:  This study demonstrates that the biological effect of circadian variation and environmental factors (eg. surgeon fatigue) has no effect on mortality in cardiac surgery. This reassures surgeons and patients alike that the outcome is independant of the time of the procedure.This should be noted prior to further work hour legislation being introduced. Mortality (Deaths/Cases)AMAFNTWDWEElective16/6372/2010/1018/8350/13    CABG2.51%0.995%0%2.16%0%Urgent48/151223/6740/3166/20605/152    CABG3.17%3.41%0%3.20%3.29%Emergency6/231/375/18AM vs AF: p<0.0110/692/9    CABG26.09%2.70%27.78%AF vs NT: p<0.0514.49%22.22%

DISCLOSURE:  Ajay Dhadwal, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543