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Off-pump surgery decreases postoperative complications and resource utilization in the elderly
W D Boyd1, N D Desai, D F Del Rizzo
1London Health Sciences Centre, University of Western Ontario, Canada. douglas.boyd@lhsc.on.ca
Insights
Off-pump coronary artery bypass (OPCAB) surgery is a safe and effective option for elderly patients, reducing hospital stay, intensive care unit time, and complications compared to conventional coronary artery bypass grafting (CABG). This approach also lowers costs and shows excellent graft patency.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) in elderly patients (>70 years) is associated with increased mortality and morbidity.
- Cardiopulmonary bypass may contribute to adverse outcomes in this population.
Purpose of the Study:
- To compare the outcomes of elderly patients undergoing off-pump coronary artery bypass (OPCAB) surgery versus conventional CABG.
- To evaluate the safety, efficacy, and cost-effectiveness of OPCAB in geriatric patients.
Main Methods:
- A retrospective review of 30 elderly OPCAB patients and 60 elderly CABG patients.
- Patients were matched for similar risk factor profiles using Parsonnet score and Ontario provincial acuity index.
Main Results:
- OPCAB patients had significantly shorter hospital stays (6.3 vs. 7.7 days) and ICU stays (24.0 vs. 36.6 hours).
- Lower incidence of atrial fibrillation (10.0% vs. 28.3%) and low output syndrome (10% vs. 31.7%) in OPCAB group.
- OPCAB resulted in a cost reduction of $1,082 per patient with 100% graft patency.
Conclusions:
- Off-pump coronary artery bypass surgery is a safe and viable option for the geriatric population.
- OPCAB significantly reduces postoperative morbidity and healthcare costs in elderly patients undergoing bypass surgery.
Background:
Bypass surgery in the elderly (age >70 years) has increased mortality and morbidity, which may be a consequence of cardiopulmonary bypass. We compare the outcomes of a cohort of elderly off-pump coronary artery bypass (OPCAB) patients with elderly conventional coronary artery bypass grafting (CABG) patients.
Methods:
Chart and provincial cardiac care registry data were reviewed for 30 consecutive elderly OPCAB patients (age 74.7 +/- 4.2 years) and 60 consecutive CABG patients (age 74.9 +/- 4.1 years, p = 0.82) with similar risk factor profiles: Parsonnet score 17.2 +/- 8.1 (OPCAB) versus 15.6 +/- 6.5 (CABG), p = 0.31; and Ontario provincial acuity index 4.5 +/- 1.9 (OPCAB) versus 4.3 +/- 2.0 (CABG), p = 0.65.
Results:
Mean hospital stay was 6.3 +/- 1.8 days for OPCAB patients and 7.7 +/- 3.9 days for CABG patients (p < 0.05). Average intensive care unit stay was 24.0 +/- 10.9 h for OPCAB patients versus 36.6 +/- 33.5 h for CABG patients (p < 0.05). Atrial fibrillation occurred in 10.0% of OPCAB patients and 28.3% of CABG patients (p < 0.05). Low output syndrome was observed in 10% of OPCAB patients and 31.7% of CABG patients (p < 0.05). Cost was reduced by $1,082 (Canadian) per patient in the OPCAB group. Postoperative OPCAB graft analysis showed 100% patency.
Conclusions:
OPCAB is safe in the geriatric population and significantly reduces postoperative morbidity and cost.
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