Skip to main content


Log in

Factors affecting postoperative morbidity and mortality in isolated coronary artery bypass graft surgery

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript



This study was conducted to investigate predictors of mortality before and after isolated coronary artery bypass grafting (CABG).


Single-institutional data on risk factors and mortality were collected for 8890 patients who underwent isolated CABG by the same group of surgeons. The relationship between risk factors and outcome was assessed using univariate and multivariate analyses in two risk models: a preoperative model (model 1) and then a pre-, intra-, and postoperative model (model 2).


The mean age of the patients (25.4% women and 74.6% men) was 58.5 ± 9.7 years. Fifty-five (0.6%) patients died after surgery. Hypercholesterolemia was the most common comorbidity factor (61.1%), followed by hypertension, a smoking habit, recent myocardial infarction (MI) <21 days, and diabetes. Postoperative tamponade, graft occlusion, and MI (0.01%) were the least common complications. The patients spent 39.7 ± 33.9 h in the intensive care unit (ICU) postoperatively. Patients were followed up for a minimum of 30 days. The multivariate analysis of our preoperative risk model revealed that the best predictors of operative mortality were a history of diabetes, hypertension, previous CABG, the presence of angina, arrhythmia, Canadian Cardiovascular Society Classification (CCS) of grade III or IV, ejection fraction (EF) ≤30%, three-vessel disease, and left main disease.


After surgery, and with the inclusion of all the pre-, intra-, and postoperative variables into model two, the following were revealed to be prognostic factors for in-hospital mortality: a history of diabetes, hypertension, the presence of angina, CCS grades III or IV, EF −30%, absence of internal mammary artery (IMA) use, prolonged cardiopulmonary bypass (CPB) time, and prolonged ICU stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Sadeghi N, Sadeghi S, Abbasi Mood Z, Karimi A. Determinants of operative mortality following primary coronary artery bypass surgery. Eur J Cardiothorac Surg 2002;21:187–192.

    Article  PubMed  Google Scholar 

  2. Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: a report of the American Collage of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 1999;34:1262–1342.

    Article  PubMed  CAS  Google Scholar 

  3. Hartz AJ, Manley JC, Walker JA, Gale HH, He Z, Assa J. Trends during 25 years of coronary artery bypass operation at St. Luke’s Medical Center in Milwaukee, Wisconsin. Ann Thorac Surg 2000;69:829–833.

    Article  PubMed  CAS  Google Scholar 

  4. STS Adult Cardiac Database. Definition of terms. Version 2.41. Society of Thoracic Surgeons. Available at

  5. Quaini E, Colombo T, Russo C, Vitali E, Pellegrini A. Hospital morbidity and mortality after myocardial revascularization surgery: current changes in risk factors. Eur J Cardio-Thorac Surg 1995;9:275–282.

    Article  CAS  Google Scholar 

  6. Naunheim KS, Fiore AC, Wadley JJ, Kanter KR, McBride LR, Pennington DG, et al. The changing mortality of myocardial revascularization: coronary artery bypass and angioplasty. Ann Thorac Surg 1988;46:666–674.

    Article  PubMed  CAS  Google Scholar 

  7. Green J, Winfield N, Sharkey P, Passman LJ. The importance of severity of illness in assessing hospital mortality. JAMA 1990;263:241–246.

    Article  PubMed  CAS  Google Scholar 

  8. Gracie JM, Rosen AK, Ash AS, McNiff KJ, Moskowitz MA. Predicting of adverse events after coronary artery bypass surgery. Ann Intern Med 1993;118:18–24.

    Google Scholar 

  9. Tuman KJ, McCarthy RJ, March RJ, Najafi H, Ivankovich AD. Morbidity and duration of ICU stay after cardiac surgery. A model for preoperative risk assessment. Chest 1992;102:36–44.

    Article  PubMed  CAS  Google Scholar 

  10. Nilsson J, Algotsson L, Höglund P, Lührs C, Brandt J. Comparison of 19 pre-operative risk stratification models in open-heart surgery. Eur Heart J 2006;27:867–874.

    Article  PubMed  Google Scholar 

  11. Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA 1992;267:2344–2348.

    Article  PubMed  CAS  Google Scholar 

  12. Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (Euro SCORE). Eur J Cardiothorac Surg 1999;16:9–13.

    Article  PubMed  CAS  Google Scholar 

  13. Hannan EL, Kilburn H Jr, Racz M, Shields E, Chassian MR. Improving the outcomes of coronary artery bypass artery bypass surgery in New York State. JAMA 1994;271:761–766.

    Article  PubMed  CAS  Google Scholar 

  14. Gabrielle F, Roques F, Michel P, Bernard A, de Vicentis C, Roques X, et al. Is the Parsonnet’s score a good predictive score of mortality in adult cardiac surgery: assessment by a French multicentre study. Eur J Cardiothorac Surg 1997;11:406–414.

    Article  PubMed  CAS  Google Scholar 

  15. Ivanov J, Borger MA, David TE, Cohen G, Walton N, Naylor CD. Predictive accuracy study: comparing a statistical model to clinicians’ estimates of outcomes after coronary bypass surgery. Ann Thorac Surg 2000;70:162–168.

    Article  PubMed  CAS  Google Scholar 

  16. Tremblay NA, Hardy JF, Perrault J, Carrier M. A simple classification of the risk in cardiac surgery: the first decade. Can J Anesth 1993;40:103–111.

    Article  PubMed  CAS  Google Scholar 

  17. Tuula SO, Kurki M, Kataja M. Preoperative Prediction of Postoperative Morbidity in Coronary Artery Bypass Grafting. Ann Thorac Surg 1996;61:1740–1745.

    Article  Google Scholar 

  18. Laurie A, Shroyer W, Plomondon ME, Grover FL, Edwards FH. The 1996 coronary artery bypass risk model: The Society of Thoracic Surgeons Adult Cardiac National Database. Ann Thorac Surg 1999;67:1205–1208.

    Article  Google Scholar 

  19. Michalopoulos A, Tzelepis G, Dafni U. Determinants of hospital mortality after coronary artery bypass grafting. Chest 1999;115:1598–1603.

    Article  PubMed  CAS  Google Scholar 

  20. Ivanov J, Weisel RD, David TE, Naylor CD. Fifteen-year trends in risk severity and operative mortality in elderly patients undergoing coronary artery bypass graft surgery. Circulation 1998;97:673–680.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Karimi, A., Ahmadi, H., Davoodi, S. et al. Factors affecting postoperative morbidity and mortality in isolated coronary artery bypass graft surgery. Surg Today 38, 890–898 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words