Off-pump surgery decreases postoperative complications and resource utilization in the elderly.
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.
Boyd
W D
WD
London Health Sciences Centre, University of Western Ontario, Canada. douglas.boyd@lhsc.on.ca
Desai
N D
ND
Del Rizzo
D F
DF
Novick
R J
RJ
McKenzie
F N
FN
Menkis
A H
AH
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000191:economics; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods*; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology* / Q000517:prevention & control; D016019:Survival Analysis