title: Why is off-pump coronary surgery uncommon in Canada? Results of a population-based survey of Canadian heart surgeons.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) is proposed to improve clinical outcomes and decrease resource use. However, off-pump surgery is not widely used in Canada. The purpose of this study was to determine the current use of OPCAB in Canada and determine why surgeons have not adopted this technique.
  
  
  RESULTS
  The study was a population-based survey of all adult Canadian cardiac surgeons in practice >1 year. Eligible division heads and surgeons were contacted by mail. Of 19 806 isolated coronary bypass surgeries performed by respondents in Canada last year, 3164 (16.0%) were performed off-pump. More than 50% of Canadian surgeons performed OPCAB in <5% of coronary cases, and only 17% of surgeons performed OPCAB in >25% of coronary cases. Only 4 responding centers performed OPCAB in >25% of cases. Respondents were divided into those who performed <5% of cases off-pump (nonadopters), 5% to 25% off-pump (intermediate users), or >25% off-pump (enthusiasts). Mean number of distal anastomoses in off-pump cases were 1.7+/-0.6, 1.6+/-0.6, and 3.3+/-0.5 for nonadopters, intermediate users, and enthusiasts, respectively (P=0.001). Eleven percent of nonadopters, 55% of intermediate users, and 81% of enthusiasts believed OPCAB improved clinical outcomes (P<0.0001). Only 23% of all respondents felt OPCAB use would increase in the next 5 years.
  
  
  CONCLUSIONS
  Concerns regarding incomplete revascularization and lack of proven clinical benefit have limited OPCAB to being performed routinely by only a small number of surgeons in Canada.
authors.affiliation: Sunnybrook and Women's Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.forename: Marc P
authors.initials: MP
authors.lastname: Pelletier
authors.forename: Hari R
authors.initials: HR
authors.lastname: Mallidi
authors.forename: George T
authors.initials: GT
authors.lastname: Christakis
authors.forename: Gideon N
authors.initials: GN
authors.lastname: Cohen
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Fremes
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Goldman
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D003625:Data Collection; D006801:Humans; D007432:Intraoperative Period; D018579:Patient Selection; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000706:statistics & numerical data*; D016896:Treatment Outcome