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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
The Annals of Thoracic Surgery
|October 30, 1999
Summary
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.