Off-pump surgery decreases postoperative complications and resource utilization in the elderly

• Published in: The Annals of thoracic surgery Vol. 68; no. 4; pp. 1490 - 1493
• Main Authors: Boyd, W.Douglas, Desai, Nimesh D., Del Rizzo, Dario F., Novick, Richard J., McKenzie, F.Neil, Menkis, Alan H.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1999; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiopulmonary Bypass - economics; Cause of Death; Coronary Artery Bypass - economics; Coronary Artery Bypass - methods; Coronary Disease - economics; Coronary Disease - mortality; Coronary Disease - surgery; Cost-Benefit Analysis; Female; Health Resources - economics; Health Resources - statistics & numerical data; Humans; Male; Medical sciences; Postoperative Complications - economics; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Human; Intensive cardiocirculatory care; Evaluation; Cardiovascular disease; Coronary heart disease; Cardiopulmonary bypass; Treatment; Aortocoronary; Bypass; Surgery; Complication; Technique; Elderly; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00951-0

Background. Bypass surgery in the elderly (age >70 years) has increased mortality and morbidity, which may be a consequence of cardiopulmonary bypass. We compare the outcomes of a cohort of elderly off-pump coronary artery bypass (OPCAB) patients with elderly conventional coronary artery bypass grafting (CABG) patients. Methods. Chart and provincial cardiac care registry data were reviewed for 30 consecutive elderly OPCAB patients (age 74.7 ± 4.2 years) and 60 consecutive CABG patients (age 74.9 ± 4.1 years, p = 0.82) with similar risk factor profiles: Parsonnet score 17.2 ± 8.1 (OPCAB) versus 15.6 ± 6.5 (CABG), p = 0.31; and Ontario provincial acuity index 4.5 ± 1.9 (OPCAB) versus 4.3 ± 2.0 (CABG), p = 0.65. Results. Mean hospital stay was 6.3 ± 1.8 days for OPCAB patients and 7.7 ± 3.9 days for CABG patients ( p < 0.05). Average intensive care unit stay was 24.0 ± 10.9 h for OPCAB patients versus 36.6 ± 33.5 h for CABG patients ( p < 0.05). Atrial fibrillation occurred in 10.0% of OPCAB patients and 28.3% of CABG patients ( p < 0.05). Low output syndrome was observed in 10% of OPCAB patients and 31.7% of CABG patients ( p < 0.05). Cost was reduced by $1,082 (Canadian) per patient in the OPCAB group. Postoperative OPCAB graft analysis showed 100% patency. Conclusions. OPCAB is safe in the geriatric population and significantly reduces postoperative morbidity and cost.