Effect of avoiding cardiopulmonary bypass in non-elective coronary artery bypass surgery: a propensity score analysis
| Autor: | Walid C. Dihmis, Ghassan Musleh, D. Mark Pullan, Daniel J.M. Keenan, Shishir Karthik, Antony D. Grayson, Ragheb Hasan, Brian M. Fabri |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Coronary Disease Internal thoracic artery Heart-Lung Machine Statistics Nonparametric law.invention Coronary artery bypass surgery law medicine.artery Internal medicine Cardiopulmonary bypass medicine Humans Renal Insufficiency Derivation Coronary Artery Bypass Emergency Treatment Diagnosis-Related Groups Aged business.industry General Medicine Odds ratio Length of Stay Middle Aged Confidence interval Surgery Logistic Models Treatment Outcome Propensity score matching Cardiology Female Morbidity Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 24:66-71 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/s1010-7940(03)00255-0 |
| Popis: | Objective: Non-elective coronary artery surgery (emergent/salvage or urgent) carries an increased risk in most risk-stratification models. Off-pump coronary surgery is increasingly used in non-elective cases. We aimed to investigate the effect of avoiding cardiopulmonary bypass on outcomes following non-elective coronary surgery. Methods: Of the 3771 consecutive coronary artery bypass procedures performed by five surgeons between April 1997 and March 2002, 828 (22%) were non-elective and 417 (50.4%) of these patients had off-pump surgery. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias. Treatment selection bias was controlled for by constructing a propensity score from core patient characteristics, which was the probability of avoiding cardiopulmonary bypass. The C statistic for this model was 0.8. Results: Off-pump patients were more likely to be hypertensive, stable, had less extensive disease and better left ventricular function. The left internal mammary artery was used in 91.8% (n ¼ 383) of off-pump patients compared to 79.3% (n ¼ 326) of on-pump cases (P , 0:001). After adjusting for the propensity score, no difference in in-hospital mortality was observed between off-pump and on-pump (adjusted odds ratio (OR) 0.83 (95% confidence intervals (CI) 0.36‐ 1.93); P ¼ 0:667). Off-pump patients were less likely to require intra-aortic balloon pump support (adjusted OR 0.44 (95% CI 0.21 ‐ 0.96); P ¼ 0:039), less likely to have renal failure (adjusted OR 0.44 (95% CI 0.22‐ 0.90); P ¼ 0:025), and have shorter lengths of stay (adjusted OR 0.51 (95% CI 0.37‐ 0.70); P , 0:001). Other morbidity outcomes were similar in both groups. Conclusions: In this experience, off-pump coronary surgery in non-elective patients is safe with acceptable results. Non-elective off-pump patients have a significantly reduced incidence of renal failure, and shorter post-operative stays compared to on-pump coronary artery bypass surgery. q 2003 Elsevier Science B.V. All rights reserved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|