Influence of body size on outcomes of off-pump coronary artery bypass surgery.
OBJECTIVE
Patients of small physical stature may be more likely selected for an on-pump coronary artery surgery (ONCAB) rather than an off-pump procedure (OPCAB). Small patients who do have OPCAB may do poorly. Our hospital demographics afford a unique opportunity to examine a group of small patients.


METHODS
Information was available over the past 4 years on 1015 patients who had isolated CABG and a calculable body surface area. Sixty-one patients had a body surface area of less than 1.5 m2 (SMALL). The 954 remaining patients were classed as larger (LARGER). Patients were compared with respect to preoperative risk factors, operative procedures, and postoperative results.


RESULTS
Among SMALL patients, 59% were Asian, 89% female, averaged slightly older, had higher STS risk scores, lower hematocrits, more severe NYHA class ratings, and less elective surgical status (P < .05) than LARGER patients. Fifty-one percent of SMALL patients had OPCAB, 44.3% received blood, 90% had an event-free course, and 4.9% died postop (versus 1.2%, P < .05). OPCAB mortality was lower than ONCAB for both SMALL and nonsmall (P < .05). Blood use was greater for SMALL than for LARGER (44% versus 20%, P < .05) but less for SMALL OPCAB than SMALL ONCAB (27% versus 62%, P < .05). No differences were noted in postop MI, CVA, or length of stay, but 30-day readmission was lower for SMALL patients (5.0% versus 7.4%).


CONCLUSIONS
Patients with small physical stature can be safely operated upon using off-pump techniques with good revascularization and postop results, despite apparently higher preop STS risk scores.
Yap
Alexander
A
Department of Cardiovascular Surgery, Seton Medical Center, San Francisco Heart & Vascular Institute, Daly City, California, USA. AlexanderYap@dochs.org
Baladi
Naoum
N
Zapolanski
Alex
A
Pliam
Michael B
MB
Shaw
Richard E
RE
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D049628:Body Size; D001830:Body Surface Area; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome