Ninety-day all-cause emergency room use among coronary artery bypass grafting patients associated with near-infrared fluorescence imaging: a retrospective cohort study

Abstract

Background: Reducing emergency room (ER) use may indicate the improved quality of patient care at index hospitalization. The aim of this study is to determine whether the use of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) during coronary artery bypass grafting (CABG) surgery is associated with a lowered 90-day all-cause ER use. Materials and Methods: This retrospective cohort study included adult patients with inpatient hospitalizations between January 2016 and June 2020 for an isolated CABG procedure at a US hospital. Propensity score matching was used to create matched cohorts to address the differences in patient, payer type, hospital, and clinical characteristics. A multivariable regression analysis was conducted to determine the association of NIRF imaging with ICG on ER use within 90 days of discharge after controlling for patient, payer type, hospital, and clinical covariates. Results: In total, 230 506 adult patients underwent an isolated CABG procedure. Less than 1% (n=1965) were assessed with NIRF imaging using ICG. There were differences in patient demographic and hospital characteristics between the treatment group (i.e. NIRF with ICG) and the comparison group (i.e. no NIRF with ICG). After controlling for covariates, a statistically significant lower 90-day all-cause ER use was documented among the treatment group (adjusted odds ratio=0.84, 95% confidence interval=0.73–0.96, P<0.009). Reasons associated with ER use were similar between the two groups. Conclusion: Routine intraoperative graft patency assessment with NIRF imaging using ICG may help to improve a patient’s care experience and reduce subsequent resource utilization. Intraoperative graft patency assessment with NIRF imaging using ICG is associated with a 90-day all-cause ER use reduction among CABG patients. Further studies are needed to compare the ER usage among centers that used this technique versus those that did not to determine if associated reductions in ER use are a center or technique-specific phenomenon.