Impact of Chronic Lymphocytic Leukemia on Outcomes and Readmissions following Cardiac Operations.

Abstract

BACKGROUND\nOutcomes of cardiac operations in patients with chronic lymphocytic leukemia (CLL) have been examined in limited series. The present study aimed to assess the impact of CLL on clinical outcomes and resource utilization following cardiac operations in a nationally representative cohort.\n\n\nMETHODS\nAll adult patients undergoing elective coronary artery bypass grafting, valve repair or valve replacement were identified utilizing the 2010-2017 Nationwide Readmissions Database. Patients were stratified by history of CLL. Incidence of in-hospital mortality, perioperative complications, blood transfusions and readmission within 90 days were examined. We subsequently performed 3:1 nearest neighbor matching between CLL and non-CLL patients for all primary and secondary outcomes of interest.\n\n\nRESULTS\nOf an estimated 1,250,882 patients undergoing cardiac operations, 0.23% had a diagnosis of CLL. Among 11,237 propensity matched patients, those with CLL had similar rates of in-hospital mortality (3.8 vs 2.6%, P=0.08) and perioperative complications (33.4 vs 33.6%, P=0.92) compared to their non-CLL counterparts. Although the incidence of infection was comparable (8.5 vs 9.4%, P=0.38), CLL patients did require blood transfusions more frequently (33.7 vs 28.4%, P=0.003) than others. Furthermore, CLL patients were more likely to be readmitted with respiratory etiologies contributing significantly to re-hospitalization.\n\n\nCONCLUSIONS\nPatients with CLL generally have similar outcomes following cardiac operations but may more commonly require blood transfusion. Blood conserving interventions may be considered in this at-risk population to improve outcomes. Furthermore, interventions to mitigate readmission deserve further exploration.