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A Comparison of Patients Undergoing On- vs. Off-Pump Coronary Artery Bypass Surgery Managed with a Fast-Track
Henrike Grützner1, Anna Flo Forner2, Massimiliano Meineri2
1Section for Pediatrics and Youth Medicine, Public Health Department, Leipzig City Government, Friedrich-Ebert-Straße 19 a, 04109 Leipzig, Germany.
Insights
On-pump and off-pump coronary artery bypass surgery show similar fast-track outcomes. Both surgical methods are comparable in ventilation time, failure rates, and complications, offering equivalent patient recovery in fast-track settings.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Fast-track protocols aim to expedite patient recovery after cardiac surgery.
- Coronary artery bypass surgery (CABG) can be performed on-pump (traditional) or off-pump.
Purpose of the Study:
- To compare outcomes of on-pump versus off-pump CABG within a fast-track management protocol.
Main Methods:
- A retrospective analysis of 3505 CABG surgeries managed with a fast-track protocol.
- Propensity score matching created two comparable groups of 926 patients each (on-pump vs. off-pump).
- Key outcome measures included ventilation time, fast-track failure rates, length of stay, and postoperative complications.
Main Results:
- No significant differences were observed in ventilation time, primary or secondary fast-track failure rates, or overall length of stay.
- Postoperative blood loss was significantly higher in the on-pump group (323 mL) compared to the off-pump group (234 mL).
- Red blood cell transfusion rates were significantly higher in the on-pump group (11%) versus the off-pump group (5%).
Conclusions:
- On-pump and off-pump CABG are comparable when managed with a fast-track protocol regarding key recovery metrics.
- While overall outcomes are similar, off-pump CABG may be associated with reduced blood loss and transfusion requirements.
Abstract:
The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55-120) min vs. off-pump 80 (55-120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.
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