OPCAB versus early mortality and morbidity: an issue between clinical relevance and statistical significance☆
| Autor: | Patrick Wouters, Chris Bogaerts, Christophe Bert, Jan Van Hemelrijck, Paul Sergeant, Koen Slabbaert, Bart Meyns, Gregory Sergeant |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Coronary artery bypass surgery medicine Humans Derivation Myocardial infarction Coronary Artery Bypass Stroke Dialysis Aged Cardiopulmonary Bypass business.industry EuroSCORE General Medicine Length of Stay Middle Aged medicine.disease Surgery Renal Replacement Therapy Treatment Outcome Propensity score matching Female Hemodialysis Epidemiologic Methods Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 25:779-785 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/j.ejcts.2004.02.013 |
| Popis: | Objective: To evaluate the impact of OPCAB on major postoperative events in a large consecutive cohort of patients, covering the complete spectrum of risk. Methods: A consecutive series of 3333 CABG patients operated in a single institution (Jan/97 ‐ Jan/03) is analyzed after a complete (98%) midterm reengineering towards off-pump surgery (Oct/99). Patients in cardiogenic shock are excluded. The on- ðN ¼ 1593Þ or off-pump ðN ¼ 1740Þ datasets are comparable for most demographic and non-cardiac variability. The studied events are early mortality, early stroke, early infarct, early dialysis and hospital stay. Three methods adjust for possible patient selection: similar datasets, forced inclusion of a saturated OPCAB propensity score and finally multivariate correction. Results: Non-risk adjusted. The 3-month survival was 96.7 ^ 0.4% (OPCAB) and 95.9 ^ 0.5% (ECC) ðP ¼ 0:2Þ: The 8-day freedom from stroke was 99.4 ^ 0.2% (OPCAB) and 98.5 ^ 0.3% (ECC) ðP ¼ 0:004Þ: The prevalence of dialysis was 1.67% in OPCAB and 2.27% in ECC ðP ¼ 0:2Þ: The 8-day freedom from infarct was 98.4 ^ 0.2% (OPCAB) and 98.3 ^ 0.2% (ECC) ðP ¼ 0:7Þ: The freedom from hospital discharge day 15 was 17.6 ^ 0.9% (OPCAB) and 18.4 ^ 0.8% (ECC) ðP ¼ 0:001Þ: Propensity score corrected and adjusted for event-related variability. The survival effect remained non-significant ðP ¼ 0:3Þ; also for patients with a EuroSCORE . 8 ðP ¼ 0:9Þ: The stroke effect became nonsignificant ðP ¼ 0:2Þ; but stayed significant for patients with severe internal carotid artery stenosis ðP ¼ 0:02Þ: The dialysis-effect remained non-significant ðP ¼ 0:6Þ; also for patients with an elevated creatinine ðP ¼ 0:7Þ: The early infarct-effect remained non-significant ðP ¼ 0:8Þ; also for the female patients ðP ¼ 0:8Þ: The hospital discharge was significantly influenced by the OPCAB approach for the total group ðP ¼ 0:02Þ as well as for the patients with EuroSCORE . 8 ðP ¼ 0:01Þ: Conclusions: The observed 20% reduction of mortality, 60% reduction of stroke and 20% reduction of dialysis were partly neutralized by the adjusting methods and demand, at least, larger datasets to obtain statistical significance. Subdatasets with fewer patients but higher risk identified risk-reducing effects for stroke. Hospital stay was shortened by the OPCAB approach. The interactions between risk, number of patients and the risk-reducing effect are the cornerstones of evidence generation for the OPCAB approach. These results were obtained through a very strict reengineering and cannot be extended to all OPCAB programs. q 2004 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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