title: Increased early postoperative morbidity with off-pump coronary artery bypass grafting surgery in patients with diabetes.
abstract: BACKGROUND
  Patients with diabetes constitute a high-risk population for myocardial revascularization due to extensive coronary disease.
  
  
  OBJECTIVE
  To compare the early postoperative outcomes of patients with diabetes undergoing off-pump or on-pump coronary artery bypass surgery.
  
  
  RESULTS
  Over a four-year period (1995 to 1998), 885 diabetics were operated for primary isolated coronary bypass; 156 patients had off-pump and 729 had on-pump coronary artery bypass surgery. Patients in the off-pump group were significantly older, had a higher incidence of hypertension and renal failure, and received fewer distal anastomoses (2.7 versus 2.9, P=0.004). Postoperative myocardial infarction, reintubation and postoperative use of intra-aortic balloon pump occurred significantly more frequently in the off-pump group (10.3% versus 5.5%, P=0.04; 8.3% versus 3.6%, P=0.03; 7.7% versus 1.5%, P=0.0001, respectively). Multivariate analysis revealed that type of surgery was an independent predictor of these complications, which occurred 1.9, 2.7 and 7.9 times more often, respectively, in the off-pump group. The 30-day mortality rate was not significantly different between the groups.
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass surgery is associated with an increased early postoperative morbidity in patients with diabetes and, thus, should be used with caution.
authors.affiliation: Research Centre, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vermes
authors.forename: Roland G
authors.initials: RG
authors.lastname: Demaria
authors.forename: Raymond
authors.initials: R
authors.lastname: Martineau
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.forename: Yves
authors.initials: Y
authors.lastname: Hébert
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006334:Heart Function Tests; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome