Comparison of the quality of life after conventional versus off-pump coronary artery bypass surgery.
OBJECTIVE
Numerous studies have focused on off-pump coronary artery bypass graft (off-pump CABG) morbidity and mortality outcomes, but few looked at the patient's perception of the technique and its effect on postoperative quality of life (QOL). We investigated and compared postoperative QOL in patients who had undergone either conventional or off-pump CABG myocardial revascularization.


METHODS
During a six-month period, 191 patients who underwent CABG surgery were prospectively studied through preoperative and six-month postoperative short-form 36 (SF-36) general health status surveys. One hundred-sixteen (60.7%) off-pump CABG patients and 75 (39.3%) conventional on-pump CABG patients were enrolled.


RESULTS
Sixteen (13.8%) off-pump patients reported improvement in physical score QOL, 84 (72.4%) reported no change, and 16 (13.8%) reported a decrease. In comparison, 20 (80.0%) patients in the on-pump CABG group reported an improvement in QOL, 42 (56.0%) were unchanged, and 13 (17.3%) reported deterioration (p = 0.28). For postoperative change in mental score, 19 (16.4%) off-pump patients reported an improvement, 85 (73.3%) stayed unchanged, and 12 (10.3%) reported a decrease compared with 8 (10.7%) conventional CABG patients reporting improvement, 60 (80.0%) showing no change, and 7 (9.3%), having a score decline (p = 0.52). In multivariate logistic regression analysis, hypertension (odds ratio [OR] 2.2, 95% confidence intervals [CI], 1.08 to 4.40, p = 0.03) and multivessel coronary artery disease (OR 2.1, 95% CI, 1.11 to 4.13, p = 0.02) emerged as independent predictors of worse physical score component score. Diabetes was associated with an improved physical score component score after CABG (OR 0.4, 95% CI, 0.17 to 0.76, p = 0.01), regardless of the surgical approach.


CONCLUSIONS
This prospective study reveals no significant differences in the expected QOL at six months after either on-pump or off-pump CABG. Patients with hypertension and multivessel coronary artery disease were more likely to have worse, while patients with diabetes have improved physical score component scores six months after CABG.
Kapetanakis
Emmanouil I
EI
Section of Cardiac Surgery, Department of Surgery, Washington Heart/Washington Hospital Center, Washington, DC, USA.
Stamou
Sotiris C
SC
Petro
Kathleen R
KR
Hill
Peter C
PC
Boyce
Steven W
SW
Bafi
Ammar S
AS
Corso
Paul J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D006973:Hypertension; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011581:Psychological Tests; D011594:Psychometrics; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome