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BACKGROUND: The analysis of indicators such as hospital readmission rates is crucial for improving the quality of services and management of hospital processes. OBJECTIVES: To identify the variables correlated with hospital readmission up to 30 days following coronary artery bypass grafting (CABG). METHODS: Cross-sectional cohort study by REPLICCAR II database (N=3,392) from June 2017 to June 2019. Retrospectively, 150 patients were analyzed to identify factors associated with hospital readmission within 30 days post-CABG using univariate and multivariate logistic regression. Analysis was conducted using software R, with a significance level of 0.05 and 95% confidence intervals. RESULTS: Out of 3,392 patients, 150 (4,42%0 were readmitted within 30 days post-discharge from CABG primarily due to infections (mediastinitis, surgical wounds, and sepsis) accounting for 52 cases (34.66%). Other causes included surgical complications (14/150, 9.33%) and pneumonia (13/150, 8.66%). The multivariate regression model identified an intercept (OR: 1.098, p<0.00001), sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) as predictors of the outcome, with an AUC of 0.70. CONCLUSION: 4.42% of patients were readmitted post-CABG, mainly due to infections. Factors such as sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) were predictors of readmission, with moderate risk discrimination (AUC: 0.70).

FUNDAMENTO: A análise de indicadores como taxa de readmissão hospitalar é crucial para aprimorar a qualidade dos serviços e gestão em processos hospitalares. OBJETIVO: Identificar as variáveis correlacionadas a readmissão hospitalar até 30 dias após cirurgia de revascularização miocárdica (CRM). MÉTODOS: Estudo de coorte transversal no banco de dados Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II)(N=3.392), de junho de 2017 a junho de 2019. Avaliaram-se retrospectivamente 150 pacientes para identificar os fatores correlacionados a readmissão hospitalar até 30 dias após-CRM via regressão logística univariada e multivariada. As análises foram realizadas no software R, com significância de 0,05 e intervalos de confiança de 95%. RESULTADOS: Cento e cinquenta pacientes foram readmitidos até 30 dias após a alta hospitalar de CRM (150/3.392, 4,42%) principalmente por infecções (mediastinite, ferida operatória e sepse) totalizando 52 casos (52/150, 34,66%), outras causas foram: complicações cirúrgicas (14/150, 9,33%) e pneumonia (13/150, 8,66%). Os preditores de readmissão identificados foram: O modelo de regressão multivariada apontou intercepto (OR: 1,098, p<0,00001), apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) como preditores do desfecho, com uma AUC de 0,70. CONCLUSÃO: 4,42% dos pacientes foram readmitidos pós-CRM, principalmente por infecções. Fatores como apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) foram preditores de readmissão, com uma discriminação de risco moderada (AUC: 0,70).

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Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

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BACKGROUND: Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. OBJECTIVE: To compare adjusted hospital outcomes between men and women undergoing CABG. METHODS: From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. RESULTS: After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). CONCLUSIONS: Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

FUNDAMENTO: Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. OBJETIVO: Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. MÉTODOS: Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. RESULTADOS: Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). CONCLUSÕES: Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

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BACKGROUND: Identifying risk factors in cardiovascular surgery assists in predictability, resulting in optimization of outcomes and cost reduction. OBJECTIVE: This study aimed to identify preoperative and intraoperative risk predictors for prolonged hospitalization after coronary artery bypass grafting (CABG) surgery in the state of São Paulo, Brazil. METHODS: A cross-sectional analysis using data from the REPLICCAR II database, a prospective, consecutive, multicenter registry that included CABG surgeries performed between August 2017 and July 2019. The primary outcome was a prolonged hospital stay (PHS), defined as a postoperative period exceeding 14 days. Univariate and multivariate logistic regression analyses were performed to identify the predictors with significance set at p <0.05. RESULTS: The median age was 63 (57-70) years and 26.55% of patients were female. Among the 3703 patients analyzed, 228 (6.16%) had a PHS after CABG, with a median hospital stay of 17 (16-20) days. Predictors of PHS after CABG included age >60 years (OR 2.05; 95% CI 1.43-2.87; p<0.001); renal failure (OR 1.73; 95% CI 1.29-2.32; p <0.001) and intraoperative red blood cell transfusion (OR 1.32; 95% CI 1.07-2.06; p=0.01). CONCLUSION: Age >60 years, renal failure, and intraoperative red blood cell transfusion were independent predictors of PHS after CABG. The identification of these variables can help in multiprofessional strategic planning aimed to enhance results and resource utilization in the state of São Paulo.

FUNDAMENTO: A identificação de fatores de riscos na cirurgia cardiovascular auxilia na previsibilidade resultando na otimização de desfechos e redução de custos. OBJETIVO: Identificação dos preditores de risco pré e intraoperatórios para internação prolongada após cirurgia de revascularização do miocárdio (CRM) no Estado de São Paulo. MÉTODOS: Análise transversal no banco de dados REPLICCAR II, registro prospectivo, consecutivo, multicêntrico que incluiu cirurgias de revascularização miocárdica realizadas entre agosto de 2017 e julho de 2019. O desfecho principal foi o tempo de internação prolongado, definida como período de pós-operatório superior a 14 (quatorze) dias. Para a identificação dos preditores foram realizadas análises de regressão logística uni- e multivariada. Os valores de p menores de 0,05 foram considerados significativos. RESULTADOS: A mediana de idade foi de 63 (57-70) anos e 26,55% eram do sexo feminino. Dos 3703 pacientes analisados, 228 (6,16%) apresentaram longa permanência hospitalar (LPH) após a CRM e a mediana da internação foi de 17 (16-20) dias. Foram preditores da LPH após a CRM: idade >60 anos (OR 2,05; IC95% 1,43 - 2,87; p<0,001); insuficiência renal (OR 1,73; IC95% 1,29 - 2,32; p<0,001) e transfusão de hemácias no intraoperatório (OR 1,32; IC 1,07 - 2,06; p=0,01). CONCLUSÃO: Nesta análise, a idade > 60 anos, insuficiência renal e a transfusão de hemácias no intraoperatório foram preditores independentes de LPH após a CRM. A identificação destas variáveis pode ajudar no planejamento estratégico multiprofissional visando melhoria de resultados e otimização de recursos no estado de São Paulo.

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INTRODUCTION: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. OBJECTIVE: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. METHODS: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. RESULTS: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. CONCLUSION: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.

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INTRODUCTION: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. OBJECTIVE: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. METHODS: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. RESULTS: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. CONCLUSION: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.

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INTRODUCTION: Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. OBJECTIVE: To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. METHODS: Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. RESULTS: After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). CONCLUSION: TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.

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ABSTRACT Introduction: Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. Objective: To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. Methods: Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. Results: After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). Conclusion: TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.

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Resumo Fundamento: A análise de indicadores como taxa de readmissão hospitalar é crucial para aprimorar a qualidade dos serviços e gestão em processos hospitalares. Objetivo: Identificar as variáveis correlacionadas a readmissão hospitalar até 30 dias após cirurgia de revascularização miocárdica (CRM). Métodos: Estudo de coorte transversal no banco de dados Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II)(N=3.392), de junho de 2017 a junho de 2019. Avaliaram-se retrospectivamente 150 pacientes para identificar os fatores correlacionados a readmissão hospitalar até 30 dias após-CRM via regressão logística univariada e multivariada. As análises foram realizadas no software R, com significância de 0,05 e intervalos de confiança de 95%. Resultados: Cento e cinquenta pacientes foram readmitidos até 30 dias após a alta hospitalar de CRM (150/3.392, 4,42%) principalmente por infecções (mediastinite, ferida operatória e sepse) totalizando 52 casos (52/150, 34,66%), outras causas foram: complicações cirúrgicas (14/150, 9,33%) e pneumonia (13/150, 8,66%). Os preditores de readmissão identificados foram: O modelo de regressão multivariada apontou intercepto (OR: 1,098, p<0,00001), apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) como preditores do desfecho, com uma AUC de 0,70. Conclusão: 4,42% dos pacientes foram readmitidos pós-CRM, principalmente por infecções. Fatores como apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) foram preditores de readmissão, com uma discriminação de risco moderada (AUC: 0,70).

Abstract Background: The analysis of indicators such as hospital readmission rates is crucial for improving the quality of services and management of hospital processes. Objectives: To identify the variables correlated with hospital readmission up to 30 days following coronary artery bypass grafting (CABG). Methods: Cross-sectional cohort study by REPLICCAR II database (N=3,392) from June 2017 to June 2019. Retrospectively, 150 patients were analyzed to identify factors associated with hospital readmission within 30 days post-CABG using univariate and multivariate logistic regression. Analysis was conducted using software R, with a significance level of 0.05 and 95% confidence intervals. Results: Out of 3,392 patients, 150 (4,42%0 were readmitted within 30 days post-discharge from CABG primarily due to infections (mediastinitis, surgical wounds, and sepsis) accounting for 52 cases (34.66%). Other causes included surgical complications (14/150, 9.33%) and pneumonia (13/150, 8.66%). The multivariate regression model identified an intercept (OR: 1.098, p<0.00001), sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) as predictors of the outcome, with an AUC of 0.70. Conclusion: 4.42% of patients were readmitted post-CABG, mainly due to infections. Factors such as sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) were predictors of readmission, with moderate risk discrimination (AUC: 0.70).

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Resumo Fundamento: A identificação de fatores de riscos na cirurgia cardiovascular auxilia na previsibilidade resultando na otimização de desfechos e redução de custos. Objetivo: Identificação dos preditores de risco pré e intraoperatórios para internação prolongada após cirurgia de revascularização do miocárdio (CRM) no Estado de São Paulo. Métodos: Análise transversal no banco de dados REPLICCAR II, registro prospectivo, consecutivo, multicêntrico que incluiu cirurgias de revascularização miocárdica realizadas entre agosto de 2017 e julho de 2019. O desfecho principal foi o tempo de internação prolongado, definida como período de pós-operatório superior a 14 (quatorze) dias. Para a identificação dos preditores foram realizadas análises de regressão logística uni- e multivariada. Os valores de p menores de 0,05 foram considerados significativos. Resultados: A mediana de idade foi de 63 (57-70) anos e 26,55% eram do sexo feminino. Dos 3703 pacientes analisados, 228 (6,16%) apresentaram longa permanência hospitalar (LPH) após a CRM e a mediana da internação foi de 17 (16-20) dias. Foram preditores da LPH após a CRM: idade >60 anos (OR 2,05; IC95% 1,43 - 2,87; p<0,001); insuficiência renal (OR 1,73; IC95% 1,29 - 2,32; p<0,001) e transfusão de hemácias no intraoperatório (OR 1,32; IC 1,07 - 2,06; p=0,01). Conclusão: Nesta análise, a idade > 60 anos, insuficiência renal e a transfusão de hemácias no intraoperatório foram preditores independentes de LPH após a CRM. A identificação destas variáveis pode ajudar no planejamento estratégico multiprofissional visando melhoria de resultados e otimização de recursos no estado de São Paulo.

Abstract Background: Identifying risk factors in cardiovascular surgery assists in predictability, resulting in optimization of outcomes and cost reduction. Objective: This study aimed to identify preoperative and intraoperative risk predictors for prolonged hospitalization after coronary artery bypass grafting (CABG) surgery in the state of São Paulo, Brazil. Methods: A cross-sectional analysis using data from the REPLICCAR II database, a prospective, consecutive, multicenter registry that included CABG surgeries performed between August 2017 and July 2019. The primary outcome was a prolonged hospital stay (PHS), defined as a postoperative period exceeding 14 days. Univariate and multivariate logistic regression analyses were performed to identify the predictors with significance set at p <0.05. Results: The median age was 63 (57-70) years and 26.55% of patients were female. Among the 3703 patients analyzed, 228 (6.16%) had a PHS after CABG, with a median hospital stay of 17 (16-20) days. Predictors of PHS after CABG included age >60 years (OR 2.05; 95% CI 1.43-2.87; p<0.001); renal failure (OR 1.73; 95% CI 1.29-2.32; p <0.001) and intraoperative red blood cell transfusion (OR 1.32; 95% CI 1.07-2.06; p=0.01). Conclusion: Age >60 years, renal failure, and intraoperative red blood cell transfusion were independent predictors of PHS after CABG. The identification of these variables can help in multiprofessional strategic planning aimed to enhance results and resource utilization in the state of São Paulo.

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Objectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.

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INTRODUCTION: Deep sternal wound infections (DSWI) are so serious and costly that hospital services continue to strive to control and prevent these outcomes. Microcosting is the more accurate approach in economic healthcare evaluation, but there are no studies in this field applying this method to compare DSWI after isolated coronary artery bypass grafting (CABG). This study aims to evaluate the incremental risk-adjusted costs of DSWI on isolated CABG. METHODS: This is a retrospective, single-center observational cohort study with a propensity score matching for infected and non-infected patients to compare incremental risk-adjusted costs between groups. Data to homogeneity sample was obtained from a multicentric database, REPLICCAR II, and additional sources of information about costs were achieved with the electronic hospital system (Si3). Inflation variation and dollar quotation in the study period were corrected using the General Market Price Index. Groups were compared using analysis of variance, and multiple linear regression was performed to evaluate the cost drivers related to the event. RESULTS: As expected, infections were costly; deep infection increased the costs by 152% and mediastinitis by 188%. Groups differed among hospital stay, exams, medications, and multidisciplinary labor, and hospital stay costs were the most critical cost driver. CONCLUSION: In summary, our results demonstrate the incremental costs of a detailed microcosting evaluation of infections on CABG patients in São Paulo, Brazil. Hospital stay was an important cost driver identified, demonstrating the importance of evaluating patients' characteristics and managing risks for a faster, safer, and more effective discharge.

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BACKGROUND: The short-term results after using arterial grafts still raise questions and doubts for medical society. OBJECTIVE: To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery. METHODS: Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk. RESULTS: After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048). CONCLUSION: Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts.

FUNDAMENTO: Os resultados a curto prazo após o uso de enxertos arteriais ainda suscitam questionamentos e dúvidas na sociedade médica. OBJETIVO: Comparar os resultados imediatos de pacientes submetidos à cirurgia de revascularização do miocárdio com enxerto arterial único versus enxertos arteriais múltiplos. MÉTODOS: Estudo de coorte transversal no Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). Os dados perioperatórios de 3122 pacientes foram agrupados pelo número de enxertos arteriais utilizados e seus desfechos foram comparados: reoperação, infecção profunda da ferida torácica (IPFT), acidente vascular cerebral, lesão renal aguda, intubação prolongada (>24 horas), tempo de internação curta (<6 dias), tempo de internação prolongada (>14 dias), morbidade e mortalidade. O Propensity Score Matching (PSM) correspondeu a 1062 pacientes, ajustado para o risco de mortalidade. RESULTADOS: Após PSM, o grupo enxerto arterial único apresentou pacientes com idade avançada, mais ex-fumantes, hipertensos, diabéticos, portadores de angina estável e infarto do miocárdio prévio. Nos enxertos arteriais múltiplos houve predomínio do sexo masculino, pneumonia recente e cirurgias de urgência. Após o procedimento, houve maior incidência de derrame pleural (p=0,042), pneumonia (p=0,01), reintubação (p=0,006), IPFT (p=0,007) e desbridamento esternal (p=0,015) no grupo de enxertos multiarteriais, porém, menor necessidade de hemotransfusão (p=0,005), infecções de extremidades (p=0,002) e menor tempo de internação (p=0,036). O uso bilateral da artéria torácica interna não foi relacionado ao aumento da taxa de IPFT, e sim a hemoglobina glicosilada >6,40% (p=0,048). CONCLUSÃO: Pacientes submetidos a técnica multiarterial apresentaram maior incidência de complicações pulmonares e IPFT, sendo que a hemoglobina glicosilada ≥6,40% teve maior influência no resultado infeccioso do que a escolha dos enxertos.

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INTRODUCTION: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of coronary artery bypass grafting (CABG). This grafting has led to an increased use of other arterial conduits, of which the radial artery (RA) is the most popular. Whether RA can have the same long-term patency as LITA is controversial. The objective of this study is to access the long-term clinical follow-up and, when available, the patency rate of RA grafts. METHODS: Twenty-six patients from a previous study with critical stenosis in all target vessels underwent complete arterial CABG with LITA and RA grafts from 1996 to 2003. They all underwent midterm multidetector computed tomography after surgery with the association of at least one patent LITA and one patent RA graft. RESULTS: Twelve patients (46%) are alive with no angina symptoms. Six patients underwent a second image exam 12 to 16 years (average of 14 years) after surgery, with a total of six LITA-LADA and 14 RA grafts with 100% patency rate. Clinical follow-up five to 23 years after surgery (average of 14 years) showed only one death 12 years after surgery related to coronary artery disease (CAD) (3,8%). Another 12 patients died of non-CAD. CONCLUSION: Patients with midterm associated LITA and RA patent grafts show similar optimal long-term patency rates of both types of grafts with excellent clinical outcome.

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INTRODUÇÃO: A fibrilação atrial constitui a principal complicação no pós-operatório de cirurgia cardiovascular. Sua gênese é multifatorial, portanto, sua rápida identifi cação é fundamental para mitigar os riscos associados. OBJETIVO: Avaliar a incidência de fi brilação atrial em pacientes submetidos à cirurgia de revascularização miocárdica (CRM) e sua relação com outras complicações no nosso cenário. MÉTODOS: Análise retrospectiva de pacientes submetidos à CRM isolada entre 2017 e 2019, pertencentes ao Registro Paulista de Cirurgia Cardiovascular (REPLICCAR II). As variáveis foram coletadas prospectivamente no REDCap seguindo as defi nições dadas pela versão 2.73 do STS Adult Cardiac Surgery Database. Os dados foram coletados com autorização prévia do Comitê de Ética local e as análises, realizadas no software R. RESULTADOS: Foram incluídos 3.803 pacientes, dos quais 605 apresentaram fi brilação atrial no pós-operatório (FAPO). De forma a ajustar os grupos, foi utilizado propensity score matching entre as seguintes variáveis (insufi ciência renal crônica/ aguda; classifi cação NYHA; diabetes mellitus; doença arterial periférica; ex-tabagista/tabagista; gênero; infarto agudo do miocárdio; necessidade de balão intra-aórtico; status cirúrgico; transfusão de hemoderivados no intraoperatório). Tais análises resultaram em 605 pacientes em cada grupo (sem FAPO vs. com FAPO). Entre os pacientes com FAPO, a média de idade foi de 67,56 anos, com prevalência do sexo masculino (445 pacientes, 73,6%). Não houve diferença estatística entre comorbidades (hipertensão arterial sistêmica, diabetes mellitus e dislipidemia), fração de ejeção, classe funcional ou risco cirúrgico (EuroSCORE). Pacientes pertencentes ao grupo com FAPO apresentaram mortalidade de 9,26% (P = 0,007), maior tempo de ventilação prolongada (P < 0,001), readmissão na unidade de terapia intensiva (P < 0,001), pneumonia (P < 0,001) e sepse (P < 0,001). Na análise múltipla, os tempos de ventilação mecânica (P = 0,044) e permanência na UTI (P < 0,001), bem como disfunção renal aguda (P = 0,032), estiveram associados à presença de FAPO. CONCLUSÃO: A fi brilação atrial no pós-operatório de CRM está associada com maior tempo de UTI e de internação, assim como com disfunção renal, pneumonia e mortalidade hospitalar.

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ABSTRACT Introduction: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of coronary artery bypass grafting (CABG). This grafting has led to an increased use of other arterial conduits, of which the radial artery (RA) is the most popular. Whether RA can have the same long-term patency as LITA is controversial. The objective of this study is to access the long-term clinical follow-up and, when available, the patency rate of RA grafts. Methods: Twenty-six patients from a previous study with critical stenosis in all target vessels underwent complete arterial CABG with LITA and RA grafts from 1996 to 2003. They all underwent midterm multidetector computed tomography after surgery with the association of at least one patent LITA and one patent RA graft. Results: Twelve patients (46%) are alive with no angina symptoms. Six patients underwent a second image exam 12 to 16 years (average of 14 years) after surgery, with a total of six LITA-LADA and 14 RA grafts with 100% patency rate. Clinical follow-up five to 23 years after surgery (average of 14 years) showed only one death 12 years after surgery related to coronary artery disease (CAD) (3,8%). Another 12 patients died of non-CAD. Conclusion: Patients with midterm associated LITA and RA patent grafts show similar optimal long-term patency rates of both types of grafts with excellent clinical outcome.

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Resumo Fundamento Os resultados a curto prazo após o uso de enxertos arteriais ainda suscitam questionamentos e dúvidas na sociedade médica. Objetivo Comparar os resultados imediatos de pacientes submetidos à cirurgia de revascularização do miocárdio com enxerto arterial único versus enxertos arteriais múltiplos. Métodos Estudo de coorte transversal no Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). Os dados perioperatórios de 3122 pacientes foram agrupados pelo número de enxertos arteriais utilizados e seus desfechos foram comparados: reoperação, infecção profunda da ferida torácica (IPFT), acidente vascular cerebral, lesão renal aguda, intubação prolongada (>24 horas), tempo de internação curta (<6 dias), tempo de internação prolongada (>14 dias), morbidade e mortalidade. O Propensity Score Matching (PSM) correspondeu a 1062 pacientes, ajustado para o risco de mortalidade. Resultados Após PSM, o grupo enxerto arterial único apresentou pacientes com idade avançada, mais ex-fumantes, hipertensos, diabéticos, portadores de angina estável e infarto do miocárdio prévio. Nos enxertos arteriais múltiplos houve predomínio do sexo masculino, pneumonia recente e cirurgias de urgência. Após o procedimento, houve maior incidência de derrame pleural (p=0,042), pneumonia (p=0,01), reintubação (p=0,006), IPFT (p=0,007) e desbridamento esternal (p=0,015) no grupo de enxertos multiarteriais, porém, menor necessidade de hemotransfusão (p=0,005), infecções de extremidades (p=0,002) e menor tempo de internação (p=0,036). O uso bilateral da artéria torácica interna não foi relacionado ao aumento da taxa de IPFT, e sim a hemoglobina glicosilada >6,40% (p=0,048). Conclusão Pacientes submetidos a técnica multiarterial apresentaram maior incidência de complicações pulmonares e IPFT, sendo que a hemoglobina glicosilada ≥6,40% teve maior influência no resultado infeccioso do que a escolha dos enxertos.

Abstract Background The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery. Methods Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk. Results After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048). Conclusion Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts.

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ABSTRACT Introduction: Deep sternal wound infections (DSWI) are so serious and costly that hospital services continue to strive to control and prevent these outcomes. Microcosting is the more accurate approach in economic healthcare evaluation, but there are no studies in this field applying this method to compare DSWI after isolated coronary artery bypass grafting (CABG). This study aims to evaluate the incremental risk-adjusted costs of DSWI on isolated CABG. Methods: This is a retrospective, single-center observational cohort study with a propensity score matching for infected and non-infected patients to compare incremental risk-adjusted costs between groups. Data to homogeneity sample was obtained from a multicentric database, REPLICCAR II, and additional sources of information about costs were achieved with the electronic hospital system (Si3). Inflation variation and dollar quotation in the study period were corrected using the General Market Price Index. Groups were compared using analysis of variance, and multiple linear regression was performed to evaluate the cost drivers related to the event. Results: As expected, infections were costly; deep infection increased the costs by 152% and mediastinitis by 188%. Groups differed among hospital stay, exams, medications, and multidisciplinary labor, and hospital stay costs were the most critical cost driver. Conclusion: In summary, our results demonstrate the incremental costs of a detailed microcosting evaluation of infections on CABG patients in São Paulo, Brazil. Hospital stay was an important cost driver identified, demonstrating the importance of evaluating patients' characteristics and managing risks for a faster, safer, and more effective discharge.