Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques.
OBJECTIVE
To assess early outcomes in the elderly population undergoing coronary revascularisation with and without cardiopulmonary bypass (CPB).


METHODS
Meta-analysis of all retrospective, non-randomised studies comparing off-pump coronary artery bypass (OPCAB) versus CPB techniques in the elderly (> 70 years) between 1999 and 2005. Age-related early outcomes of interest were death, stroke, atrial fibrillation (AF), renal failure and length of stay in hospital. The random effects model was used. Sensitivity and heterogeneity were analysed.


RESULTS
Analysis of 14 non-randomised studies comprising 4921 patients (OPCAB, 1533 (31.1%) and CPB, 3388 (68.9%)) showed a significantly lower incidence of death in the OPCAB group (odds ratio (OR) 0.48, 95% CI 0.28 to 0.84). This effect was greater in OPCAB octogenarians (OR 0.26, 95% CI 0.12 to 0.57). The pattern of incidence of stroke among the OPCAB octogenarians (OR 0.19, 95% CI 0.07 to 0.56) was similar. The incidence of AF was lower in the OPCAB group (OR 0.77, 95% CI 0.61 to 0.97). The incidence of renal failure did not differ. Length of hospital stay was shorter in the OPCAB group, although with significant heterogeneity.


CONCLUSIONS
OPCAB may be associated with lower incidence of death, stroke and AF in the elderly, which may result in shorter length of hospital stay. A large randomised trial would confirm whether the elderly would benefit more from OPCAB surgery.
Panesar
S S
SS
Department of Surgical Oncology & Technology, Imperial College, London, UK.
Athanasiou
T
T
Nair
S
S
Rao
C
C
Jones
C
C
Nicolaou
M
M
Darzi
A
A
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D007902:Length of Stay; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome