Left Upper Lobectomy After Coronary Artery Bypass Grafting: A National Analysis of Postoperative Outcomes

<h2>Abstract</h2><h3>Background</h3> To determine whether previous coronary artery bypass grafting (CABG) is a risk factor for postoperative mortality, morbidity, or worse quality metrics in patients undergoing left upper lobectomy. <h3>Methods</h3> Using International Classification of Diseases 10th revision codes, the Healthcare Cost and Utilization Project Nationwide Readmissions Database was queried for patients with pulmonary neoplasms undergoing left upper lobectomy from 2016 to 2018 and categorized by history of CABG. Sociodemographic factors, comorbidities, and hospital characteristics were analyzed using univariable and multivariable regressions. <h3>Results</h3> A total of 11,118 patients met inclusion criteria, of whom 465 (4.2%) had a history of CABG. On bivariate analysis, postoperative myocardial infarction and atrial fibrillation rates were higher (<i>P</i> < .004) in patients with prior CABG. However, multivariable modeling revealed no association between history of CABG and worse outcomes across all metrics: in-hospital mortality (odds ratio [OR], 0.806; <i>P</i> = .563), cardiovascular complications (OR, 0.826; <i>P</i> = .0985), pulmonary complications (OR, 0.849; <i>P</i> = .154), length of stay (relative risk, 0.982; <i>P</i> = .619), 30-day readmission (OR, 1.057; <i>P</i> = .747), and 90-day readmission (OR, 1.137; <i>P</i> = .396). Thoracotomy patients experienced worse outcomes across all metrics (<i>P</i> < .05) compared with thoracoscopy. Prior CABG was not associated with worse outcomes in either thoracoscopy or thoracotomy subgroup analyses. Although not statistically significant (<i>P</i> = .255), patients with previous CABG had approximately $6500 in additional charges. <h3>Conclusions</h3> Prior CABG in patients undergoing left upper lobectomy is not associated with increased mortality, morbidity, length of stay, readmissions, or increased hospital charges. Thoracoscopy may be preferred in this population and is associated with improved outcomes compared with thoracotomy.