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Published on: March 27, 2018
The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity
N C Patel1, A D Grayson, M Jackson
1Department of Cardiothoracic Surgery, The Cardiothoracic Centre - Liverpool, Thomas Drive, Liverpool L14 3PE, UK.
Insights
Off-pump coronary artery bypass surgery shows no increased mortality risk. This procedure significantly reduces post-operative stroke and hospital stay compared to traditional on-pump grafting.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Surgical Outcomes Research
Background:
- Off-pump coronary artery bypass (OPCAB) is increasingly favored over conventional on-pump grafting due to reported better outcomes.
- Evaluating OPCAB's impact on in-hospital mortality and morbidity is crucial for surgical practice.
Purpose of the Study:
- To assess the effect of OPCAB on in-hospital mortality and morbidity.
- To adjust for patient and disease characteristics in comparing OPCAB with on-pump coronary artery bypass grafting.
Main Methods:
- A retrospective analysis of 10,941 isolated coronary artery bypass surgeries performed between April 1997 and March 2001.
- Logistic regression was used to analyze in-hospital mortality and morbidity, adjusting for confounding variables.
- 7.7% of surgeries were performed off-pump.
Main Results:
- The crude odds ratio for death was 0.48 (P=0.023), but adjusted for risk factors, it was 0.59 (P=0.105).
- Off-pump patients showed a significantly reduced risk of post-operative stroke (adjusted OR 0.26; P=0.008) and shorter hospital stays.
- Other post-operative morbidity outcomes were comparable between the groups.
Conclusions:
- Off-pump coronary artery bypass does not increase in-hospital mortality risk.
- OPCAB grafting leads to a significant reduction in post-operative morbidity compared to cardiopulmonary bypass.
- OPCAB is a safe and effective alternative for coronary artery bypass surgery.
Objective:
Off-pump coronary artery bypass (OPCAB) surgery is being increasingly reported to show better outcomes compared to conventional on bypass grafting. We examined the effect of OPCAB on in-hospital mortality and morbidity, while adjusting for patient and disease characteristics, in four institutions in the North West of England.
Methods:
Between April 1997 and March 2001, 10,941 consecutive patients underwent isolated coronary artery bypass surgery at these four institutions. Of these, 7.7% were performed off-pump. We used logistic regression to examine the effect of OPCAB on in-hospital mortality and morbidity after adjusting for potentially confounding variables.
Results:
The crude odds ratio (OR) for death (off-pump versus on-pump coronary bypass grafting) was 0.48 (95% confidence interval, CI 0.26-0.92; P=0.023). After adjustment for all major risk factors, the OR for death was 0.59 (95% CI 0.31-1.12; P=0.105). Off-pump patients had a substantially reduced risk of post-operative stroke (0.6 versus 2.3%, respectively; adjusted OR 0.26 (95% CI 0.09-0.70; P=0.008) and a significant reduction in post-operative hospital stay. Other morbidity outcomes were similar in both groups.
Conclusions:
Off-pump coronary artery bypass incurs no increased risk of in-hospital mortality. In contrast, there is a significant reduction in morbidity in patients undergoing off-pump coronary bypass grafting when compared to that performed on cardiopulmonary bypass.
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