On-pump vs. off-pump coronary artery bypass surgery at a non-academic community hospital: have biocompatibility improvements eliminated the superiority of off-pump surgery?
OBJECTIVE
Standard coronary artery bypass grafting (CABG) surgery involves cardiopulmonary bypass (CPB) but given concerns over neurological and inflammatory complications related to CPB, many patients receive so-called off-pump procedures (OPCABG). Our objective is to determine if the recent improvements in the biocompatibility of CPB circuitry have improved post-operative outcomes at the community hospital level, particularly in terms of hospital length of stay (LOS), stroke and post-operative infection.


METHODS
We analyzed hospital LOS, incidence of stroke, infection, and mortality along with several clinical variables in 209 patients (38% underwent OPCABG) at a single, non academic community hospital. We constructed a series of forward, stepwise, multiple-variable regression models using mediastinal infection, hospital LOS, and stroke as dependant variables.


RESULTS
OPCABG was associated with a shorter median hospital LOS (3 days vs. 4 days; p=0.0001) and a reduced occurrence of stroke (0% vs. 7.6%; p=0.03). However, mediastinal infections occurred more commonly in OPCABG cases (10% vs. 2.2%; p=0.02). CABG and pre-existing renal disease were predictors of increased hospital LOS (p< 0.0001) whereas CABG was the only factor associated with decreased risk of mediastinal infection (OR=0.21 (0.05-0.80); p=0.02).


CONCLUSIONS
At the community level, OPCABG appears to be superior in terms of LOS and incidence of stroke. Paradoxically, CABG surgery demonstrates a reduced rate of mediastinal infection.
Madden
N J
NJ
The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, Univesity of Pittsburgh, Pittsburgh 15261, USA.
Demarsico
A J
AJ
Schocker
L A
LA
Venkataraman
R
R
Kellum
J A
JA
D000368:Aged; D001672:Biocompatible Materials; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D004867:Equipment Design; D006355:Heart-Lung Machine; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D007902:Length of Stay; D008477:Mediastinal Diseases / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D020521:Stroke / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome
D001672:Biocompatible Materials