title: Short-term clinical outcomes after off-pump coronary artery bypass grafting at a single Veterans Affairs Medical Center.
abstract: BACKGROUND
  We retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting (CABG) was employed.
  
  
  METHODS
  Over a 5 year period all consecutive patients that underwent CABG at our VA Medical Center were assigned to a surgeon who either performs the CABG exclusively off-pump or to one who performed the CABG on-pump. The higher risk patients were assigned preferentially for off-pump revascularization. VASQIP (VA Hospitals Surgical Quality Improvement Program) data between 10/2007 and 12/2012 were retrospectively reviewed at our VA Medical Center and the short term outcomes were assessed.
  
  
  RESULTS
  A total of 252 consecutive patients underwent off-pump CABG (n = 170) and on-pump CABG (n = 82). There were significantly more patients with low LVEF (<45 %; p = 0.008) and cerebrovascular disease in the off-pump group (p = 0.024). The number of patients smoking at the time of surgery was significantly higher in the off-pump group (p = 0.002) as well. The 30-day composite morbidity and mortality was 6 % for all CABG patients and significantly lower with off-pump vs. on-pump CABG (3.5 % vs. 11 %; p = 0.019). There were no conversions from off-pump to on-pump surgery.
  
  
  CONCLUSIONS
  A selective strategy to direct higher risk patients towards an off-pump revascularization yielded favorable outcomes in an unselected veteran population treated at a single VA Medical Center over a 5 year period.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
authors.forename: Entela B
authors.initials: EB
authors.lastname: Lushaj
authors.affiliation: William S. Middleton Veterans Hospital, Madison, Wisconsin, USA.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Schreiner
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
authors.forename: Besa
authors.initials: B
authors.lastname: Jonuzi
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
authors.forename: Abbasali
authors.initials: A
authors.lastname: Badami
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
authors.forename: Nilto
authors.initials: N
authors.lastname: DeOliveira
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA. Lozon@surgery.wisc.edu.
authors.forename: Lucian
authors.initials: L
authors.lastname: Lozonschi
mesh_terms: D000368:Aged; D019985:Benchmarking; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data*; D014922:Wisconsin
keywords: CABG; Off-Pump; Outcomes; Veterans Affairs