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Postoperative hyperthermia following off-pump versus on-pump coronary artery bypass surgery
Jeffrey A Clark1, Shahar Bar-Yosef, Amanda Anderson
1Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Off-pump coronary artery bypass graft (CABG) surgery patients experience less postoperative hyperthermia compared to traditional on-pump CABG. This suggests a reduced inflammatory response may be linked to avoiding cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes
- Thermoregulation
Background:
- Postoperative hyperthermia is common after coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB).
- The inflammatory response to CPB is often implicated in fever development.
- The temperature patterns following off-pump CABG (OPCAB) have not been well-described.
Purpose of the Study:
- To describe the postoperative temperature pattern in patients undergoing OPCAB.
- To compare the temperature patterns between OPCAB and on-pump CABG surgery.
Main Methods:
- Retrospective, observational study design.
- Involved consenting patients undergoing either CABG or OPCAB procedures at a tertiary care university hospital.
- Data collection focused on postoperative temperature monitoring.
Main Results:
- 89% of CABG patients experienced temperature elevations above 38°C, compared to 44% of OPCAB patients (P=0.04).
- Peak body temperature was significantly higher in on-pump CABG patients (38.5°C ± 0.4°C) versus OPCAB patients (37.9°C ± 0.5°C; P=0.002).
- The area under the curve for temperatures >38°C was also greater in the CABG group (1.6 ± 1.7°C/hr vs. 0.4 ± 1.2°C/hr; P=0.02).
Conclusions:
- Patients undergoing OPCAB surgery exhibit significantly less hyperthermia postoperatively compared to those having on-pump CABG.
- The reduced incidence and severity of hyperthermia after OPCAB may be associated with a diminished inflammatory response.
- Further research is needed to fully elucidate the mechanisms behind these observed temperature differences.
Objective:
Hyperthermia is common in the first 24 hours following coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). An inflammatory response to CPB is often implicated in the pathophysiology of this fever. Unlike CABG with CPB, the temperature pattern after off-pump CABG (OPCAB), where CPB is avoided, has not yet been described. The purpose of this study was to describe the postoperative temperature pattern following OPCAB and to compare it with that following on-pump cardiac surgery.
Design:
Retrospective, observational study.
Setting:
Tertiary care university hospital.
Participants:
Consenting patients undergoing CABG or OPCAB procedures.
Interventions:
Observational.
Measurements And Main Results:
Of the CABG patients, 89% had temperature elevations above 38 degrees C, versus 44% of the OPCAB patients (P = 0.04). Peak body temperature was higher in the on-pump patients (CABG 38.5 degrees C +/- 0.4 degrees C versus OPCAB 37.9 degrees C +/- 0.5 degrees C; P = 0.002), as was the area under the curve for temperatures greater than 38 degrees C (CABG 1.6 +/- 1.7 degrees C/hr versus OPCAB 0.4 +/- 1.2 degrees C/hr; P = 0.02).
Conclusions:
Off-pump CABG surgery patients experience less hyperthermia compared with on-pump CABG patients. The reasons for a lower incidence and severity of hyperthermia after OPCAB surgery are not known, but may be related to a reduced inflammatory response.
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