Impact of surgical urgency on outcomes after coronary artery bypass surgery: A retrospective cohort study

Impact of surgical urgency on outcomes after coronary artery bypass surgery: A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of surgical urgency on outcomes after coronary artery bypass surgery: A retrospective cohort study Hemn Abdulrahman Abdullah, Darya Nadir Saeed, Sherzad Ali Ismael, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5766962/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background : surgical urgency is a significant factor influencing outcomes of coronary artery bypass grafting. This study aims to assess the impact of urgency on postoperative complications and patient outcomes. Methods : a retrospective cohort analysis was conducted. out of 205 patients, 38 patients were selected, who underwent coronary artery bypass graft at the Dr. Hemn foundation, Erbil, Iraq, from February 2021 to December 2023. Patients were divided equally into urgent and elective groups, matched for age, gender, chronic disease presence, and type of surgery. Results : no significant difference was observed in age (p-value = 1.000), gender (p-value = 1.000), and body mass index (p-value = 0.748). the prevalence of posterior descending artery stenosis in the elective group was observed (p-value = 0.039). The urgent group experienced longer total hospital stay and intensive care unit. Postoperatively the urgent group experienced more blood loss compared to the elective group (p-value = 0.019) and had higher serum creatinine levels (p-value = 0.021). Conclusions : urgent coronary artery bypass grafting was associated with increased postoperative challenges, particularly in terms of renal function, blood loss, and extended hospital stay. Trial registration: retrospectively registered surgery urgency coronary artery bypass grafting postoperative outcomes Background the urgency in surgical cases is a critical factor that directly influences patient outcomes (1). Studies highlight that urgent surgeries carry increased risks compared to elective procedures (2), often resulting in higher postoperative complication rates, including morbidity and mortality, due to factors like limited preoperative preparation and underlying health condition of patients (3). In cardiothoracic surgery context, the urgency associated with coronary artery bypass graft (CABG) significantly impacts postoperative complications (4). Urgent cases experiencing acute coronary syndrome (ACS) with added complications are observed to face significant risk (5). Research from the Swedish SWEDENHEART registry and other studies indicated that meticulous preoperative assessment is critical in urgent cases to minimize complications and improve outcomes (6). Urgent CABG procedures, often necessitated by unstable coronary conditions like ACS (7, 8), are associated with increased postoperative risks compared to elective surgeries (9). Urgent cases frequently exhibit elevated rates of complications (4). However, Studies suggest promising outcomes and increase in quality of life when conducting urgent CABG is needed, despite that operative risk may increase (10). The aim of the study is to examine urgency in CABG particularly by evaluating impact of timing between urgent and elective procedures on postoperative complications and overall patient outcomes. Methods Definitions Urgent case is defined as a surgery that must be performed during the same hospital admission to prevent worsening of a patient’s, typically indicated in cases of severe or unstable symptoms such as angina that could lead to complications if delayed. While the elective case is defined as a planned surgery for stable patients with coronary artery disease who may have controlled symptoms or high-risk coronary anatomy but no immediate danger, allowing for the procedure to be scheduled in advance without urgent risk (11). Case selection a retrospective cohort study was conducted using data of 38 out of 205 patients who underwent CABG at the independent Dr. Hemn foundation, located on the third floor of Shar hospital in Erbil, Iraq which provide services for conducting cardiac surgeries. patient data were extracted from electronic health records spanning February 2021 to December 2023. of the 38 patients, 19 were classified as urgent cases, while 19 were classified as elective cases. All patients underwent CABG of any technique, as detailed in Table 1 . Table 1 type of surgeries conducted for the elective and urgent group Type of surgery Urgent (n = 19) Elective (n = 19) Minimally invasive coronary artery bypass 13 15 OFF-pump 9 13 ON-pump 4 2 Traditional CABG Traditional (ON-pump) 5 4 OFF-pump 0 2 Conversion to bypass 1 0 to minimize confounding, patients were matched across both groups by gender, age, Prescence of chronic disease and type of surgery. Matching criteria were as follows: gender was directly matched, age was matched with an acceptable variation of 5 years, and chronic disease (including diabetes mellitus, hypertension, chronic kidney disease, and ischemic heart disease) were matched based on Prescence. surgical type was matched according to the specific CABG procedure conducted. Data analysis Statistical analyses were performed using SPSS software version 26. P value ≤ 0.05 was considered statistically significant. Shapiro- wilk tests assessed data normality. for non-normally distributed variables, the Mann- Whitney U test compared postoperative outcomes between the urgent and elective groups. for normally distributed variables, the independent t test was used. spearman’s rank correlation coefficient was calculated to assess relationships between age and postoperative serum creatinine, BMI and intensive care unit (ICU) stay duration, ejection fraction (EF) and total hospitalization days, and surgery duration and postoperative hemoglobin levels. correlation strength and direction were interpreted based on coefficient values. for categorical variables, chi- square tests were applied to 2x2 contingency tables when expected cell counts met standard assumptions (i.e., no more than 20% of cells with expected count below 5). for tables where expected counts exceeded these limits, Fisher's exact test was used. in contingency tables larger than 2x2, the likelihood ratio chi- square test was applied to assess association. Results As shown in Table 2 , there were no significant age difference between the groups (p-value = 1.000), and gender distribution was balanced (p-value = 1.000). Although the elective group exhibited a lower BMI (p-value = 0.748), along with higher HBA1c (p-value = 0.157) and ejection fraction (EF) (p-value = 0.065), none of those was significant statistically. Regarding Renal function tests, both serum creatinine (p-value = 0.271) and blood urea (p-value = 0.483) levels were higher in the urgent group with no significance statistically. Table 2 preoperative and demographic characteristics Variables Urgent (n = 19) Elective (n = 19) P value Age (year) 61.32 ± 9.31 61.32 ± 9.52 1.000 Gender (Male) 14 14 1.000 BMI (Kg/m 2 ) 29.97 ± 5.02 28.28 ± 7.68 0.748 HBA1c 6.63 ± 1.43 7.34 ± 1.81 0.157 PT (seconds) 14.13 ± 0.83 13.26 ± 3.18 0.793 EF (%) 49.42 ± 13.02 56.58 ± 8.62 0.065 INR (ratio) 1.15 ± 0.08 1.14 ± 0.1 0.748 Renal function test S. Creatinine (mg/dL) 1.31 ± 1.31 1.01 ± 0.31 0.271 B. Urea (mg/dL) 45.21 ± 24.04 38.73 ± 22.14 0.483 CBC Hb (g/dL) 12.57 ± 2.16 12.91 ± 1.69 0.597 WBC (x10 3 / µL) 10.04 ± 8.81 7.69 ± 1.51 0.483 PLT (x10 3 / µL) 258.16 ± 94.86 250.16 ± 97.3 0.640 BMI: body mass index, HBA1c: glycated hemoglobin, PT: prothrombin time, EF: ejection fraction, INR: international normalized ratio, S. Creatinine: Serum Creatinine, B. Urea: Blood Urea, CBC: Complete blood count, WBC: white blood cell, HB: hemoglobin, PLT: platelet count Regarding chronic disease and comorbidities (Table 3 ), there were no significant difference except for the prevalence of posterior descending artery stenosis (p-value = 0.039). diabetes mellitus (p-value = 0.732) and hypertension (p-value = 0.501) prevalence were comparable between the groups, with no significant difference. Additionally, Liver disease (p-value = 0.311), chronic lung disease (p-value = 0.311), and hypothyroidism (p-value = 0.311) were absent in the elective group, with each condition observed in a single case within the urgent group. Table 3 chronic disease and comorbidities across the groups. Variables Urgent (n = 19) Elective (n = 19) P value Diabetes Mellitus 12 13 0.732 Hypertension 8 6 0.501 Liver Disease 1 0 0.311 Chronic Lung Disease 1 0 0.311 Hypothyroidism 1 0 0.311 PDA 0.039 Critical Stenosis 6 13 Significant Stenosis 1 1 No stenosis 12 5 RCA 0.296 Critical Stenosis 13 10 Significant Stenosis 5 3 No stenosis 1 3 LM Coronary Artery 0.707 Critical Stenosis 5 3 Significant Stenosis 3 4 No stenosis 11 12 LAD Coronary Artery 0.391 Critical Stenosis 16 15 Significant stenosis 3 2 No stenosis 0 2 PDA: posterior descending artery, RCA: right coronary artery, LM coronary artery: left main coronary artery, LAD coronary artery: left anterior descending coronary artery. [Table 3 should appear here]. Table 4 summarizes intraoperative and postoperative findings, Significance difference was observed in total hospital stay, by being longer in the urgent group (p-value = 0.004). There was no statistically significant difference in surgery duration and ICU stay between the groups, although the urgent group experienced longer duration in both categories (p-value = 0.089 and 0.146, respectively). Postoperatively serum creatinine levels were higher in the urgent group (1.88 ± 1.92 mg/dL vs 1.03 ± 0.43 mg/dL, p-value = 0.021), along with Blood urea levels (58 ± 31.1 mg/dL vs 41.95 ± 23.5 mg/dL, p-value = 0.075). Table 4 Intraoperative support and postoperative outcomes between urgent and elective patients Variables Urgent (n = 19) Elective (n = 19) P value Surgery duration (hours) 5.4 ± 2.0 4.5 ± 1.2 0.089 Total hospital stays (days) 5.8 ± 2.1 4.2 ± 1.2 0.004 ICU stay (hours) 22.2 ± 14.5 14 .8 ± 4.4 0.146 Intra support Dobutamine 18 18 1.000 Noradrenaline 10 6 0.189 Adrenaline 10 7 0.328 Postoperative EF (%) 54.21 ± 5.3 55.26 ± 4.9 0.608 Renal function test S.creatinine (mg/dL) 1.88 ± 1.92 1.03 ± 0.43 0.021 B. urea (mg/dL) 58.8 ± 31.1 41.95 ± 23.5 0.075 CBC WBC (x10 3 / µL) 16.61 ± 7.07 13.42 ± 2.90 0.237 HB (g/dl) 9.97 ± 1.65 10.47 ± 1.10 0.281 PLT (x10³/µL) 171.89 ± 59.13 189.21 ± 62.13 0.385 Pints of Blood Products Transfused until Discharge blood 6 9 0.663 Platelet 3 4 0.242 ICU: intensive care unit, EF: Ejection fraction, S. Creatinine: Serum Creatinine, B. Urea: Blood Urea, CBC: Complete blood count, WBC: white blood cell, HB: hemoglobin, PLT: platelet count. [Table 4 should appear here]. Table 5 presents the post operative complications, eight patients in the urgent group experienced blood loss > 1000 ml, compared to one patient in the elective group, the difference was significant statistically (p-value = 0.019), with no mortality rate in either group. Incidence of readmission to ICU, shock, acute kidney injury and respiratory failure differed between the groups, though it lacked significant difference statistically. Table 5 Postoperative complications between diabetic and non-diabetic patients. Complications Urgent (n = 19) Elective (n = 19) P value Blood Loss > 1000 mL Without Reoperation. 8 1 0.019 Readmission to ICU 1 0 1.000 Shock 1 0 1.000 Acute Kidney Injury 5 3 0.693 Respiratory Failure 4 7 0.283 Discussion In our study, we revealed notable trends and specific differences in perioperative and postoperative outcomes by comparing urgent vs elective CABG patient. This research underscores the impact of urgent surgeries on various postoperative outcomes, especially in terms of bleeding, hospital stay, and renal function, compared to elective cases. Previous studies have shown that urgent cases often carry increased risks due to time constraints on preoperative optimization and the acute nature of patient condition(12, 13). In our study, preoperative EF was near statistical significance between urgent and elective cases, suggesting a potential influence of EF in determining CABG procedure urgency. A lower EF preoperatively can indicate patient instability, necessitating timely intervention, which may impact the choice of surgical approach or timing. Research has shown that patients with reduced EF face a higher risk of complications during and after CABG, underscoring the need to account for EF in surgical planning(14). The extended duration of surgery observed in urgent cases, although not statistically significant, likely reflects the hemodynamic instability often encountered during urgent CABG procedures. Hemodynamically instability in urgent cases typically requires added intraoperative management, which can prolong the surgery. This aligns with findings from Liu et al, who reported longer operative times in urgent CABG cases due to increased need for stabilization and intraoperative support (15). Furthermore, our study showed a significantly longer hospital stay in urgent cases and a trend toward prolonged ICU stays, which suggests that urgent CABG patients may require extended postoperative care due to their baseline instability at the time of surgery. This trend may highlight the need for early postoperative interventions, such as enhanced recovery protocols tailored to urgent cases, which could potentially reduce the length of hospitalization and improve patient outcomes. Postoperative bleeding complications were significantly higher in the urgent group, with blood loss exceeding 1000 ml observed more frequently than in elective cases (p = 0.019). This is consistent with Schumer et al. who reported that urgent cardiac surgeries generally have higher bleeding risks due to limited time for preoperative optimization and patient stabilization(16). The notable blood loss also correlated with elevated postoperatively serum creatinine level, suggesting an association between substantial blood loss and renal strain. Studies by Mangano et al. and Karkouti et al. indicate that acute kidney injury risk is heightened by factors like excessive blood loss and hypoperfusion, both of which can compromise renal function in the postoperative period(17, 18). These finding reinforce the need for cautious fluid and renal management in urgent CABG patients to reduce the likelihood of renal complication. Enhanced monitoring of blood loss and timely fluid management could help in mitigating these risks and protecting renal function. The findings of this study emphasize the importance of tailored perioperative care in urgent CABG patients. Given the higher risks of blood loss and renal impairment, implementing focused monitoring protocols could improve patient outcomes. Specific strategies, such as closer intraoperative hemodynamic control and early renal support postoperatively, could be beneficial, additionally, prompt and individualized fluid management may help counteract the effects of significant blood loss, protecting renal function. These finding highlight the need for surgical teams to develop specialized care pathways for urgent CABG cases, potentially reducing postoperative complications and enhancing recovery. This study’s primary limitation is its small sample size, which may restrict the ability to detect subtle differences in outcomes. Expanding the cohort in future research could yield more robust findings. Additionally, investigating specific preoperative interventions for urgent cases would offer deeper insights into optimizing care for high-risk CABG patients. Conclusions overall, this study adds to the evidence that urgency in CABG is associated with specific postoperative challenges, such as renal impairment, increased blood loss, and prolonged hospitalizations. Future research should further explore tailored interventions for urgent CABG patients to enhance the safety and efficacy of urgent surgical interventions. Abbreviations CABG = coronary artery bypass graft ACS = acute coronary syndrome ICU = intensive care unit EF = ejection fraction Declarations Ethical approval and consent to participate This study was conducted in accordance with declaration of helsinki and was approved by the ethics committee of Dr. Hemn foundation’s research center (no. 15) on 12/12/2024. Consent for publication Not applicable Availablity of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Authors’ contributions HA, DS, SI, AF, and MH have made substantial contributions to the design of the work; HA and DS in acquisition of data, AF and MH in analysis and interpretation of data. AF and MH prepared tables 1-5. SI, AF, and MH drafted the work. all authors read and approved the final manuscript. Acknowledgements Not applicable. References Quintero LA, Hernandez J, Orduno Villa N, Romero D, Spector C, Ngo L, et al. Surgical Urgency, Patient Comorbidities, and Socioeconomic Factors in Surgical Site Infections in Pediatric Surgery. Am Surg. 2024; doi: 10.1177/00031348241260265 Mullen MG, Michaels AD, Mehaffey JH, Guidry CA, Turrentine FE, Hedrick TL, Friel CM. Risk associated with complications and mortality after urgent surgery vs elective and emergency surgery: implications for defining “quality” and reporting outcomes for urgent surgery. JAMA surgery. 2017; doi: 10.1001/jamasurg.2017.0918 Elassal AA, Al-Ebrahim KE, Debis RS, Ragab ES, Faden MS, Fatani MA, et al. Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate. J Cardiothorac Surg. 2021; doi: 10.1186/s13019-021-01545-4 Guan Z, Guan X, Gu K, Lin X, Lin J, Zhou W, et al. Short-term outcomes of on- vs off-pump coronary artery bypass grafting in patients with left ventricular dysfunction: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2020; doi: 10.1186/s13019-020-01115-0 Chen Y, Almeida AA, Goldstein J, Shardey GC, Pick AW, Moshinsky R, et al. URGENT AND EMERGENCY CORONARY ARTERY BYPASS GRAFTING FOR ACUTE CORONARY SYNDROMES. ANZ Journal of Surgery. 2006; doi: 10.1111/j.1445-2197.2006.03864.x Harnek J, Nilsson J, Friberg O, James S, Lagerqvist B, Hambraeus K, et al. The 2011 outcome from the Swedish Health Care Registry on Heart Disease (SWEDEHEART). Scand Cardiovasc J. 2013; doi: 10.3109/14017431.2013.780389 Stone GW, Bertrand M, Colombo A, Dangas G, Farkouh ME, Feit F, et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J. 2004; doi: 10.1016/j.ahj.2004.04.036 Kim D-K, Yoo K-J, Hong YS, Chang B-C, Kang M-S. Clinical outcome of urgent coronary artery bypass grafting. Journal of Korean medical science. 2007; doi: 10.3346/jkms.2007.22.2.270 Senanayake EL, Howell NJ, Evans J, Ray D, Mascaro J, Graham TR, et al. Contemporary outcomes of urgent coronary artery bypass graft surgery following non-ST elevation myocardial infarction: urgent coronary artery bypass graft surgery consistently outperforms Global Registry of Acute Coronary Events predicted survival†. European Journal of Cardio-Thoracic Surgery. 2012; doi: 10.1093/ejcts/ezr303 Luqman Z, Ansari J, Siddiqui FJ, Sami SA. Is urgent coronary artery bypass grafting a safe option in octogenarians? A developing country perspective. Interactive CardioVascular and Thoracic Surgery. 2009; doi: 10.1510/icvts.2009.204156 Members* WC, Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; doi: 10.1161/CIR.0b013e31823b5fee Mohammad WA, Ashraf Z, Sayed HF. Urgent versus elective coronary artery bypass grafting in acute coronary artery syndrome. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2018; doi: 10.1016/j.jescts.2017.12.005 Abd-Alaal MM, Alsabban MA, Abbas OA, Alshaer AA, Al-Saddique A, Fouda M. Timing of revascularization after acute myocardial infarction. Asian Cardiovascular and Thoracic Annals. 2010; doi: 10.1177/0218492310361001 Najafi MS, Nematollahi S, Vakili-Basir A, Jalali A, Gholami A, Dashtkoohi M, et al. Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft. IJC Heart & Vasculature. 2024; doi: 10.1016/j.ijcha.2024.101412 Liu J-J, Kong Q-Y, You B, Liang L, Xiao W, Ma X-l, et al. Surgical Challenges in Multi‐Vessel Minimally Invasive Coronary Artery Bypass Grafting. Journal of Interventional Cardiology. 2021; doi: 10.1155/2021/1195613 Schumer EM, Chaney JH, Trivedi JR, Linsky PL, Williams ML, Slaughter MS. Emergency coronary artery bypass grafting: indications and outcomes from 2003 through 2013. Texas Heart Institute Journal. 2016;43(3):214-9. doi: 10.14503/THIJ-14-4978 Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Annals of internal medicine. 1998;128(3):194-203. doi: 10.7326/0003-4819-128-3-199802010-00005 Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; doi: 10.1161/CIRCULATIONAHA.108.786913 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 14 Apr, 2025 Reviews received at journal 12 Apr, 2025 Reviews received at journal 24 Mar, 2025 Reviewers agreed at journal 21 Mar, 2025 Reviewers agreed at journal 03 Mar, 2025 Reviewers invited by journal 03 Mar, 2025 Editor assigned by journal 09 Jan, 2025 Submission checks completed at journal 09 Jan, 2025 First submitted to journal 05 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5766962","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399954743,"identity":"108bc2c3-1f16-4aef-a0e1-aa7b4f96beab","order_by":0,"name":"Hemn Abdulrahman Abdullah","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Hemn","middleName":"Abdulrahman","lastName":"Abdullah","suffix":""},{"id":399954744,"identity":"8cd93d6b-e001-47d8-beef-6b14c1e5be4f","order_by":1,"name":"Darya Nadir Saeed","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Darya","middleName":"Nadir","lastName":"Saeed","suffix":""},{"id":399954746,"identity":"16597930-1c1f-465e-b2b1-29f8f040f0f3","order_by":2,"name":"Sherzad Ali Ismael","email":"","orcid":"","institution":"Ministry of Higher Education and Scientific Research","correspondingAuthor":false,"prefix":"","firstName":"Sherzad","middleName":"Ali","lastName":"Ismael","suffix":""},{"id":399954747,"identity":"f6bcac5a-94f7-4abb-ade0-7b240cf6aacf","order_by":3,"name":"Abdullah Haider Flayeh","email":"data:image/png;base64,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","orcid":"","institution":"Salahaddin University-Erbil","correspondingAuthor":true,"prefix":"","firstName":"Abdullah","middleName":"Haider","lastName":"Flayeh","suffix":""},{"id":399954749,"identity":"8162ed8c-0155-4ca3-a78f-900fabc85eda","order_by":4,"name":"Marwan Abdullah Hussein","email":"","orcid":"","institution":"Hawler Medical University","correspondingAuthor":false,"prefix":"","firstName":"Marwan","middleName":"Abdullah","lastName":"Hussein","suffix":""}],"badges":[],"createdAt":"2025-01-05 09:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5766962/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5766962/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-025-03768-1","type":"published","date":"2025-12-24T15:57:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99172332,"identity":"aabf02ec-6843-43f7-911a-8a975471a854","added_by":"auto","created_at":"2025-12-29 16:07:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":694330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5766962/v1/c9887d56-b9e2-49ce-8ece-e788f647fc64.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of surgical urgency on outcomes after coronary artery bypass surgery: A retrospective cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003ethe urgency in surgical cases is a critical factor that directly influences patient outcomes (1). Studies highlight that urgent surgeries carry increased risks compared to elective procedures (2), often resulting in higher postoperative complication rates, including morbidity and mortality, due to factors like limited preoperative preparation and underlying health condition of patients (3).\u003c/p\u003e \u003cp\u003eIn cardiothoracic surgery context, the urgency associated with coronary artery bypass graft (CABG) significantly impacts postoperative complications (4). Urgent cases experiencing acute coronary syndrome (ACS) with added complications are observed to face significant risk (5). Research from the Swedish SWEDENHEART registry and other studies indicated that meticulous preoperative assessment is critical in urgent cases to minimize complications and improve outcomes (6).\u003c/p\u003e \u003cp\u003eUrgent CABG procedures, often necessitated by unstable coronary conditions like ACS (7, 8), are associated with increased postoperative risks compared to elective surgeries (9). Urgent cases frequently exhibit elevated rates of complications (4). However, Studies suggest promising outcomes and increase in quality of life when conducting urgent CABG is needed, despite that operative risk may increase (10).\u003c/p\u003e \u003cp\u003eThe aim of the study is to examine urgency in CABG particularly by evaluating impact of timing between urgent and elective procedures on postoperative complications and overall patient outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eDefinitions\u003c/strong\u003e \u003cp\u003eUrgent case is defined as a surgery that must be performed during the same hospital admission to prevent worsening of a patient\u0026rsquo;s, typically indicated in cases of severe or unstable symptoms such as angina that could lead to complications if delayed. While the elective case is defined as a planned surgery for stable patients with coronary artery disease who may have controlled symptoms or high-risk coronary anatomy but no immediate danger, allowing for the procedure to be scheduled in advance without urgent risk (11).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eCase selection\u003c/p\u003e \u003cp\u003ea retrospective cohort study was conducted using data of 38 out of 205 patients who underwent CABG at the independent Dr. Hemn foundation, located on the third floor of Shar hospital in Erbil, Iraq which provide services for conducting cardiac surgeries. patient data were extracted from electronic health records spanning February 2021 to December 2023. of the 38 patients, 19 were classified as urgent cases, while 19 were classified as elective cases. All patients underwent CABG of any technique, as detailed in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003etype of surgeries conducted for the elective and urgent group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElective (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMinimally invasive coronary artery bypass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOFF-pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eON-pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraditional CABG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional (ON-pump)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOFF-pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConversion to bypass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eto minimize confounding, patients were matched across both groups by gender, age, Prescence of chronic disease and type of surgery. Matching criteria were as follows: gender was directly matched, age was matched with an acceptable variation of 5 years, and chronic disease (including diabetes mellitus, hypertension, chronic kidney disease, and ischemic heart disease) were matched based on Prescence. surgical type was matched according to the specific CABG procedure conducted.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS software version 26. P value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant. Shapiro- wilk tests assessed data normality. for non-normally distributed variables, the Mann- Whitney U test compared postoperative outcomes between the urgent and elective groups. for normally distributed variables, the independent t test was used. spearman\u0026rsquo;s rank correlation coefficient was calculated to assess relationships between age and postoperative serum creatinine, BMI and intensive care unit (ICU) stay duration, ejection fraction (EF) and total hospitalization days, and surgery duration and postoperative hemoglobin levels. correlation strength and direction were interpreted based on coefficient values. for categorical variables, chi- square tests were applied to 2x2 contingency tables when expected cell counts met standard assumptions (i.e., no more than 20% of cells with expected count below 5). for tables where expected counts exceeded these limits, Fisher's exact test was used. in contingency tables larger than 2x2, the likelihood ratio chi- square test was applied to assess association.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were no significant age difference between the groups (p-value\u0026thinsp;=\u0026thinsp;1.000), and gender distribution was balanced (p-value\u0026thinsp;=\u0026thinsp;1.000). Although the elective group exhibited a lower BMI (p-value\u0026thinsp;=\u0026thinsp;0.748), along with higher HBA1c (p-value\u0026thinsp;=\u0026thinsp;0.157) and ejection fraction (EF) (p-value\u0026thinsp;=\u0026thinsp;0.065), none of those was significant statistically. Regarding Renal function tests, both serum creatinine (p-value\u0026thinsp;=\u0026thinsp;0.271) and blood urea (p-value\u0026thinsp;=\u0026thinsp;0.483) levels were higher in the urgent group with no significance statistically.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epreoperative and demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElective (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT (seconds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR (ratio)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRenal function test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS. Creatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB. Urea (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.21\u0026thinsp;\u0026plusmn;\u0026thinsp;24.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.73\u0026thinsp;\u0026plusmn;\u0026thinsp;22.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCBC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (x10\u003csup\u003e3\u003c/sup\u003e/ \u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT (x10\u003csup\u003e3\u003c/sup\u003e/ \u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e258.16\u0026thinsp;\u0026plusmn;\u0026thinsp;94.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250.16\u0026thinsp;\u0026plusmn;\u0026thinsp;97.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eBMI: body mass index, HBA1c: glycated hemoglobin, PT: prothrombin time, EF: ejection fraction, INR: international normalized ratio, S. Creatinine: Serum Creatinine, B. Urea: Blood Urea, CBC: Complete blood count, WBC: white blood cell, HB: hemoglobin, PLT: platelet count\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding chronic disease and comorbidities (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), there were no significant difference except for the prevalence of posterior descending artery stenosis (p-value\u0026thinsp;=\u0026thinsp;0.039). diabetes mellitus (p-value\u0026thinsp;=\u0026thinsp;0.732) and hypertension (p-value\u0026thinsp;=\u0026thinsp;0.501) prevalence were comparable between the groups, with no significant difference. Additionally, Liver disease (p-value\u0026thinsp;=\u0026thinsp;0.311), chronic lung disease (p-value\u0026thinsp;=\u0026thinsp;0.311), and hypothyroidism (p-value\u0026thinsp;=\u0026thinsp;0.311) were absent in the elective group, with each condition observed in a single case within the urgent group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003echronic disease and comorbidities across the groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElective (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Lung Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePDA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCritical Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRCA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCritical Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLM Coronary Artery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCritical Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLAD Coronary Artery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCritical Stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePDA: posterior descending artery, RCA: right coronary artery, LM coronary artery: left main coronary artery, LAD coronary artery: left anterior descending coronary artery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e should appear here].\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes intraoperative and postoperative findings, Significance difference was observed in total hospital stay, by being longer in the urgent group (p-value\u0026thinsp;=\u0026thinsp;0.004). There was no statistically significant difference in surgery duration and ICU stay between the groups, although the urgent group experienced longer duration in both categories (p-value\u0026thinsp;=\u0026thinsp;0.089 and 0.146, respectively). Postoperatively serum creatinine levels were higher in the urgent group (1.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92 mg/dL vs 1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43 mg/dL, p-value\u0026thinsp;=\u0026thinsp;0.021), along with Blood urea levels (58\u0026thinsp;\u0026plusmn;\u0026thinsp;31.1 mg/dL vs 41.95\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5 mg/dL, p-value\u0026thinsp;=\u0026thinsp;0.075).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative support and postoperative outcomes between urgent and elective patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElective (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery duration (hours)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal hospital stays (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU stay (hours)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 .8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntra support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDobutamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNoradrenaline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdrenaline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEF (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRenal function test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.creatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB. urea (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;31.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.95\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCBC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (x10\u003csup\u003e3\u003c/sup\u003e/ \u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.61\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHB (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT (x10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171.89\u0026thinsp;\u0026plusmn;\u0026thinsp;59.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.21\u0026thinsp;\u0026plusmn;\u0026thinsp;62.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePints of Blood Products Transfused until Discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eblood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eICU: intensive care unit, EF: Ejection fraction, S. Creatinine: Serum Creatinine, B. Urea: Blood Urea, CBC: Complete blood count, WBC: white blood cell, HB: hemoglobin, PLT: platelet count.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e should appear here].\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the post operative complications, eight patients in the urgent group experienced blood loss\u0026thinsp;\u0026gt;\u0026thinsp;1000 ml, compared to one patient in the elective group, the difference was significant statistically (p-value\u0026thinsp;=\u0026thinsp;0.019), with no mortality rate in either group. Incidence of readmission to ICU, shock, acute kidney injury and respiratory failure differed between the groups, though it lacked significant difference statistically.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative complications between diabetic and non-diabetic patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElective (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Loss\u0026thinsp;\u0026gt;\u0026thinsp;1000 mL Without Reoperation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission to ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute Kidney Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we revealed notable trends and specific differences in perioperative and postoperative outcomes by comparing urgent vs elective CABG patient. This research underscores the impact of urgent surgeries on various postoperative outcomes, especially in terms of bleeding, hospital stay, and renal function, compared to elective cases. Previous studies have shown that urgent cases often carry increased risks due to time constraints on preoperative optimization and the acute nature of patient condition(12, 13).\u003c/p\u003e \u003cp\u003eIn our study, preoperative EF was near statistical significance between urgent and elective cases, suggesting a potential influence of EF in determining CABG procedure urgency. A lower EF preoperatively can indicate patient instability, necessitating timely intervention, which may impact the choice of surgical approach or timing. Research has shown that patients with reduced EF face a higher risk of complications during and after CABG, underscoring the need to account for EF in surgical planning(14).\u003c/p\u003e \u003cp\u003eThe extended duration of surgery observed in urgent cases, although not statistically significant, likely reflects the hemodynamic instability often encountered during urgent CABG procedures. Hemodynamically instability in urgent cases typically requires added intraoperative management, which can prolong the surgery. This aligns with findings from Liu et al, who reported longer operative times in urgent CABG cases due to increased need for stabilization and intraoperative support (15). Furthermore, our study showed a significantly longer hospital stay in urgent cases and a trend toward prolonged ICU stays, which suggests that urgent CABG patients may require extended postoperative care due to their baseline instability at the time of surgery. This trend may highlight the need for early postoperative interventions, such as enhanced recovery protocols tailored to urgent cases, which could potentially reduce the length of hospitalization and improve patient outcomes.\u003c/p\u003e \u003cp\u003ePostoperative bleeding complications were significantly higher in the urgent group, with blood loss exceeding 1000 ml observed more frequently than in elective cases (p\u0026thinsp;=\u0026thinsp;0.019). This is consistent with Schumer et al. who reported that urgent cardiac surgeries generally have higher bleeding risks due to limited time for preoperative optimization and patient stabilization(16). The notable blood loss also correlated with elevated postoperatively serum creatinine level, suggesting an association between substantial blood loss and renal strain. Studies by Mangano et al. and Karkouti et al. indicate that acute kidney injury risk is heightened by factors like excessive blood loss and hypoperfusion, both of which can compromise renal function in the postoperative period(17, 18). These finding reinforce the need for cautious fluid and renal management in urgent CABG patients to reduce the likelihood of renal complication. Enhanced monitoring of blood loss and timely fluid management could help in mitigating these risks and protecting renal function.\u003c/p\u003e \u003cp\u003eThe findings of this study emphasize the importance of tailored perioperative care in urgent CABG patients. Given the higher risks of blood loss and renal impairment, implementing focused monitoring protocols could improve patient outcomes. Specific strategies, such as closer intraoperative hemodynamic control and early renal support postoperatively, could be beneficial, additionally, prompt and individualized fluid management may help counteract the effects of significant blood loss, protecting renal function. These finding highlight the need for surgical teams to develop specialized care pathways for urgent CABG cases, potentially reducing postoperative complications and enhancing recovery.\u003c/p\u003e \u003cp\u003eThis study\u0026rsquo;s primary limitation is its small sample size, which may restrict the ability to detect subtle differences in outcomes. Expanding the cohort in future research could yield more robust findings. Additionally, investigating specific preoperative interventions for urgent cases would offer deeper insights into optimizing care for high-risk CABG patients.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eoverall, this study adds to the evidence that urgency in CABG is associated with specific postoperative challenges, such as renal impairment, increased blood loss, and prolonged hospitalizations. Future research should further explore tailored interventions for urgent CABG patients to enhance the safety and efficacy of urgent surgical interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCABG = coronary artery bypass graft\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACS = acute coronary syndrome\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICU = intensive care unit\u003c/p\u003e\n\u003cp\u003eEF = ejection fraction\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with declaration of helsinki and was approved by the ethics committee of Dr. Hemn foundation’s research center (no. 15) on 12/12/2024.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailablity of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003eAuthors’ contributions\u003c/p\u003e\n\u003cp\u003eHA, DS, SI, AF, and MH have made substantial contributions to the design of the work; HA and DS in acquisition of data, AF and MH in analysis and interpretation of data. AF and MH prepared tables 1-5. SI, AF, and MH drafted the work. all authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eQuintero LA, Hernandez J, Orduno Villa N, Romero D, Spector C, Ngo L, et al. Surgical Urgency, Patient Comorbidities, and Socioeconomic Factors in Surgical Site Infections in Pediatric Surgery. Am Surg. 2024; doi: 10.1177/00031348241260265\u003c/li\u003e\n \u003cli\u003eMullen MG, Michaels AD, Mehaffey JH, Guidry CA, Turrentine FE, Hedrick TL, Friel CM. Risk associated with complications and mortality after urgent surgery vs elective and emergency surgery: implications for defining \u0026ldquo;quality\u0026rdquo; and reporting outcomes for urgent surgery. JAMA surgery. 2017; doi: 10.1001/jamasurg.2017.0918\u003c/li\u003e\n \u003cli\u003eElassal AA, Al-Ebrahim KE, Debis RS, Ragab ES, Faden MS, Fatani MA, et al. Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate. J Cardiothorac Surg. 2021; doi: 10.1186/s13019-021-01545-4\u003c/li\u003e\n \u003cli\u003eGuan Z, Guan X, Gu K, Lin X, Lin J, Zhou W, et al. Short-term outcomes of on- vs off-pump coronary artery bypass grafting in patients with left ventricular dysfunction: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2020; doi: 10.1186/s13019-020-01115-0\u003c/li\u003e\n \u003cli\u003eChen Y, Almeida AA, Goldstein J, Shardey GC, Pick AW, Moshinsky R, et al. URGENT AND EMERGENCY CORONARY ARTERY BYPASS GRAFTING FOR ACUTE CORONARY SYNDROMES. ANZ Journal of Surgery. 2006; doi: 10.1111/j.1445-2197.2006.03864.x\u003c/li\u003e\n \u003cli\u003eHarnek J, Nilsson J, Friberg O, James S, Lagerqvist B, Hambraeus K, et al. The 2011 outcome from the Swedish Health Care Registry on Heart Disease (SWEDEHEART). Scand Cardiovasc J. 2013; doi: 10.3109/14017431.2013.780389\u003c/li\u003e\n \u003cli\u003eStone GW, Bertrand M, Colombo A, Dangas G, Farkouh ME, Feit F, et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J. 2004; doi: 10.1016/j.ahj.2004.04.036\u003c/li\u003e\n \u003cli\u003eKim D-K, Yoo K-J, Hong YS, Chang B-C, Kang M-S. Clinical outcome of urgent coronary artery bypass grafting. Journal of Korean medical science. 2007; doi: 10.3346/jkms.2007.22.2.270\u003c/li\u003e\n \u003cli\u003eSenanayake EL, Howell NJ, Evans J, Ray D, Mascaro J, Graham TR, et al. Contemporary outcomes of urgent coronary artery bypass graft surgery following non-ST elevation myocardial infarction: urgent coronary artery bypass graft surgery consistently outperforms Global Registry of Acute Coronary Events predicted survival\u0026dagger;. European Journal of Cardio-Thoracic Surgery. 2012; doi: 10.1093/ejcts/ezr303\u003c/li\u003e\n \u003cli\u003eLuqman Z, Ansari J, Siddiqui FJ, Sami SA. Is urgent coronary artery bypass grafting a safe option in octogenarians? A developing country perspective. Interactive CardioVascular and Thoracic Surgery. 2009; doi: 10.1510/icvts.2009.204156\u003c/li\u003e\n \u003cli\u003eMembers* WC, Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; doi: 10.1161/CIR.0b013e31823b5fee\u003c/li\u003e\n \u003cli\u003eMohammad WA, Ashraf Z, Sayed HF. Urgent versus elective coronary artery bypass grafting in acute coronary artery syndrome. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2018; doi: 10.1016/j.jescts.2017.12.005\u003c/li\u003e\n \u003cli\u003eAbd-Alaal MM, Alsabban MA, Abbas OA, Alshaer AA, Al-Saddique A, Fouda M. Timing of revascularization after acute myocardial infarction. Asian Cardiovascular and Thoracic Annals. 2010; doi: 10.1177/0218492310361001\u003c/li\u003e\n \u003cli\u003eNajafi MS, Nematollahi S, Vakili-Basir A, Jalali A, Gholami A, Dashtkoohi M, et al. Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft. IJC Heart \u0026amp; Vasculature. 2024; doi: 10.1016/j.ijcha.2024.101412\u003c/li\u003e\n \u003cli\u003eLiu J-J, Kong Q-Y, You B, Liang L, Xiao W, Ma X-l, et al. Surgical Challenges in Multi‐Vessel Minimally Invasive Coronary Artery Bypass Grafting. Journal of Interventional Cardiology. 2021; doi: 10.1155/2021/1195613\u003c/li\u003e\n \u003cli\u003eSchumer EM, Chaney JH, Trivedi JR, Linsky PL, Williams ML, Slaughter MS. Emergency coronary artery bypass grafting: indications and outcomes from 2003 through 2013. Texas Heart Institute Journal. 2016;43(3):214-9. doi: 10.14503/THIJ-14-4978\u003c/li\u003e\n \u003cli\u003eMangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Annals of internal medicine. 1998;128(3):194-203. doi: 10.7326/0003-4819-128-3-199802010-00005\u003c/li\u003e\n \u003cli\u003eKarkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; doi: 10.1161/CIRCULATIONAHA.108.786913\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"surgery urgency, coronary artery bypass grafting, postoperative outcomes","lastPublishedDoi":"10.21203/rs.3.rs-5766962/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5766962/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003cstrong\u003e:\u003c/strong\u003e surgical urgency is a significant factor influencing outcomes of coronary artery bypass grafting. This study aims to assess the impact of urgency on postoperative complications and patient outcomes.\u003c/p\u003e\n\u003cp\u003eMethods\u003cstrong\u003e:\u003c/strong\u003e a retrospective cohort analysis was conducted. out of 205 patients, 38 patients were selected, who underwent coronary artery bypass graft at the Dr. Hemn foundation, Erbil, Iraq, from February 2021 to December 2023. Patients were divided equally into urgent and elective groups, matched for age, gender, chronic disease presence, and type of surgery.\u003c/p\u003e\n\u003cp\u003eResults\u003cstrong\u003e:\u003c/strong\u003e no significant difference was observed in age (p-value = 1.000), gender (p-value = 1.000), and body mass index (p-value = 0.748). the prevalence of posterior descending artery stenosis in the elective group was observed (p-value = 0.039). The urgent group experienced longer total hospital stay and intensive care unit. Postoperatively the urgent group experienced more blood loss compared to the elective group (p-value = 0.019) and had higher serum creatinine levels (p-value = 0.021).\u003c/p\u003e\n\u003cp\u003eConclusions\u003cstrong\u003e: \u003c/strong\u003eurgent coronary artery bypass grafting was associated with increased postoperative challenges, particularly in terms of renal function, blood loss, and extended hospital stay.\u003c/p\u003e\n\u003cp\u003eTrial registration: retrospectively registered\u003c/p\u003e","manuscriptTitle":"Impact of surgical urgency on outcomes after coronary artery bypass surgery: A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 07:27:42","doi":"10.21203/rs.3.rs-5766962/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-14T13:06:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-12T07:31:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-24T09:30:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224585095973578993281754185546375198109","date":"2025-03-22T03:24:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293400149894407050390104835704679148012","date":"2025-03-03T12:43:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-03T08:56:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-09T12:27:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-09T12:24:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-01-05T09:00:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"58a4f1ce-4c4e-4110-9537-3602aca8d9a0","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:01:36+00:00","versionOfRecord":{"articleIdentity":"rs-5766962","link":"https://doi.org/10.1186/s13019-025-03768-1","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2025-12-24 15:57:12","publishedOnDateReadable":"December 24th, 2025"},"versionCreatedAt":"2025-01-13 07:27:42","video":"","vorDoi":"10.1186/s13019-025-03768-1","vorDoiUrl":"https://doi.org/10.1186/s13019-025-03768-1","workflowStages":[]},"version":"v1","identity":"rs-5766962","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5766962","identity":"rs-5766962","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}