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Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort.
Eur J Cardiothorac Surg. 2005 Jan; 27(1):94-8.EJ

Abstract

OBJECTIVE

The combination of total arterial revascularisation and avoidance of cardiopulmonary bypass may provide additional benefits to patients receiving complete arterial grafting with cardiopulmonary bypass. We performed a propensity-matched cohort study of complete arterial off-pump and on-pump coronary surgery and examined differences in in-hospital mortality and morbidity.

METHODS

Three hundred and sixty patients who underwent off-pump coronary surgery with complete arterial grafting between April 1997 and September 2002 were matched to 360 patients who received coronary surgery with cardiopulmonary bypass and complete arterial grafting. To match off-pump with unique on-pump patients, logistic regression was used to develop a propensity score for off-pump surgery. The C statistic for this model was 0.79. Off-pump patients were matched to unique on-pump patients with an identical 5-digit propensity score. If this could not be done, we then proceeded to a 4-, 3-, 2-, or 1-digit match.

RESULTS

Patient characteristics were well matched. There was no difference in in-hospital mortality between the groups. Off-pump patients were less likely to develop sternal wound infections compared to the on-pump group (2.5 versus 5.8%; P=0.03), and had significantly lower blood loss (675 versus 780 ml; P<0.001), red blood cell unit transfusion (8.6 versus 38.9%; P<0.001), enzyme rises (13 versus 23 U/l; P<0.001), inotrope support (11.9 versus 28.9%; P<0.001), and ventilation times (5 versus 8 h; P<0.001). Intensive care unit and hospital stay were also significantly lower in the off-pump patients.

CONCLUSIONS

Off-pump coronary surgery with complete arterial revascularisation can significantly reduce in-hospital morbidity and lengths of stay compared to conventional on-pump coronary surgery.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, The Cardiothoracic Centre Liverpool, Thomas Drive, Liverpool L14 3PE, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15621478

Citation

Pandey, Ragini, et al. "Total Arterial Revascularisation: Effect of Avoiding Cardiopulmonary Bypass On In-hospital Mortality and Morbidity in a Propensity-matched Cohort." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 27, no. 1, 2005, pp. 94-8.
Pandey R, Grayson AD, Pullan DM, et al. Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort. Eur J Cardiothorac Surg. 2005;27(1):94-8.
Pandey, R., Grayson, A. D., Pullan, D. M., Fabri, B. M., & Dihmis, W. C. (2005). Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 27(1), 94-8.
Pandey R, et al. Total Arterial Revascularisation: Effect of Avoiding Cardiopulmonary Bypass On In-hospital Mortality and Morbidity in a Propensity-matched Cohort. Eur J Cardiothorac Surg. 2005;27(1):94-8. PubMed PMID: 15621478.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort. AU - Pandey,Ragini, AU - Grayson,Antony D, AU - Pullan,D Mark, AU - Fabri,Brian M, AU - Dihmis,Walid C, PY - 2004/09/09/received PY - 2004/10/19/revised PY - 2004/10/27/accepted PY - 2004/12/29/pubmed PY - 2005/5/20/medline PY - 2004/12/29/entrez SP - 94 EP - 8 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 27 IS - 1 N2 - OBJECTIVE: The combination of total arterial revascularisation and avoidance of cardiopulmonary bypass may provide additional benefits to patients receiving complete arterial grafting with cardiopulmonary bypass. We performed a propensity-matched cohort study of complete arterial off-pump and on-pump coronary surgery and examined differences in in-hospital mortality and morbidity. METHODS: Three hundred and sixty patients who underwent off-pump coronary surgery with complete arterial grafting between April 1997 and September 2002 were matched to 360 patients who received coronary surgery with cardiopulmonary bypass and complete arterial grafting. To match off-pump with unique on-pump patients, logistic regression was used to develop a propensity score for off-pump surgery. The C statistic for this model was 0.79. Off-pump patients were matched to unique on-pump patients with an identical 5-digit propensity score. If this could not be done, we then proceeded to a 4-, 3-, 2-, or 1-digit match. RESULTS: Patient characteristics were well matched. There was no difference in in-hospital mortality between the groups. Off-pump patients were less likely to develop sternal wound infections compared to the on-pump group (2.5 versus 5.8%; P=0.03), and had significantly lower blood loss (675 versus 780 ml; P<0.001), red blood cell unit transfusion (8.6 versus 38.9%; P<0.001), enzyme rises (13 versus 23 U/l; P<0.001), inotrope support (11.9 versus 28.9%; P<0.001), and ventilation times (5 versus 8 h; P<0.001). Intensive care unit and hospital stay were also significantly lower in the off-pump patients. CONCLUSIONS: Off-pump coronary surgery with complete arterial revascularisation can significantly reduce in-hospital morbidity and lengths of stay compared to conventional on-pump coronary surgery. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/15621478/Total_arterial_revascularisation:_effect_of_avoiding_cardiopulmonary_bypass_on_in_hospital_mortality_and_morbidity_in_a_propensity_matched_cohort_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2004.10.049 DB - PRIME DP - Unbound Medicine ER -