title: Operative mortality and stroke after on-pump vs off-pump surgery in high-risk patients: an analysis of 83,914 coronary bypass operations.
abstract: OBJECTIVE
  The objective of this study was to compare the early outcomes of off-pump and on-pump surgeries in high-risk patient groups.
  
  
  METHODS
  The outcomes of 83,914 high-risk patients undergoing off-pump or on-pump isolated coronary bypass surgery identified from the Nationwide Inpatient Sample from 2005 to 2010 were compared using propensity analysis.
  
  
  RESULTS
  Off-pump surgery was associated with a significant reduction in stroke rates compared with on-pump surgery in propensity-matched patients ≥ 80 years (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52-0.93, P = 0.02), those with peripheral vascular disease (OR 0.53, 95% CI 0.36-0.77, P = 0.001) and those with aortic atherosclerosis (OR 0.30, 95% CI 0.13-0.72, P = 0.007). In these high-risk subgroups, off-pump surgery was associated with an absolute risk reduction in stroke rates of 0.5, 0.5 and 1.2%, respectively: the minimum number needed to treat to prevent one stroke is 200 patients. There was no significant difference in in-hospital mortality or the incidence of postoperative renal failure or respiratory failure between off-pump and on-pump surgeries in these patient subgroups, or in patients with preoperative renal failure, or chronic obstructive airways disease.
  
  
  CONCLUSIONS
  High-risk patients undergoing coronary artery bypass surgery gain a short-term benefit from off-pump approaches due to a small absolute reduction in the risk of postoperative stroke.
authors.affiliation: The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Cavallaro
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.forename: Matthew
authors.initials: M
authors.lastname: Seigerman
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome
keywords: Coronary artery bypass; Off-pump coronary artery bypass