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Influence of Body Size on Clinical Outcome in Patients Undergoing Coronary Surgery with or Without Cardiopulmonary Bypass
Author(s) -
Ascione R,
Rees K,
Chamberlain MH,
Ciulli F,
Bryan AJ,
Angelini GD
Publication year - 2002
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1046/j.1540-8191.2002.01014_3.x
Subject(s) - medicine , cardiopulmonary bypass , outcome (game theory) , cardiac surgery , cardiology , surgery , mathematical economics , mathematics
Objective: Coronary artery bypass grafting (CABG) in overweight patients carries significant morbidity. We compare the effectiveness of off‐pump coronary artery bypass (OPCAB) surgery versus conventional CABG using cardiopulmonary bypass and cardioplegic arrest, in a consecutive series of overweight patients. Methods: From April 1996 to April 2001, data from 4321 patients undergoing coronary revascularisation (mortality 1.4%) were prospectively entered into the Patients Analysis and Tracking System. Data were extracted for all patients with a body mass index (BMI) ≥ 25. In hospital mortality and early morbidity were compared between patients undergoing on‐ and off‐pump coronary surgery. A risk‐adjusted analysis was also carried out to assess the influence of surgery on outcomes. Results: 2844 overweight patients with BMI ≥ 25 were identified, and of these 674 (23.7%) were operated on with off‐pump surgery. On‐pump patients were less likely to have unstable angina, hypercholesterolaemia, to have coronary disease involving the left main stem, or to have a BMI ≥ 30 . However, they had more extensive coronary disease, were more likely to have suffered previous myocardial infarction, and received more grafts than those undergoing off‐pump surgery. Intra‐ and post‐operative arrhythmias, inotropic use, and post‐operative low cardiac output, use of IABP, blood loss, transfusion requirement, chest infections, neurological complications including permanent stroke, ICU and hospital stay all were significantly reduced in the off‐pump group (all p < 0.05 ). After adjustment for age, gender, ejection fraction, extent of coronary disease, and degree of urgency, odd ratios (ORs) for most of the adverse outcomes investigated, confirmed significant benefit of off‐pump surgery (table). The point estimate of the adjusted effect size for in‐hospital mortality also indicated benefit from off‐pump surgery (table).VariableOn‐Pump (2169)Off‐Pump (674)OR/Mean Difference95% CIpDeath 20 (0.92%) 2 (0.29%) 0.37 0.08, 1.59 0.18 Postoperative MI 35 (1.6%) 14 (2.0%) 1.37 0.72, 2.62 0.337 New Inotropes 879 (40.5%) 219 (32.5%) 0.8 0.66, 0.97 0.02 New IABP 54 (2.5%) 5 (0.7%) 0.32 0.12, 0.8 0.015 Ward arrhythmia 320 (14.8%) 65 (9.6%) 0.63 0.47, 0.84 0.002 Chest Infection 106 (4.9%) 14 (2.1%) 0.43 0.24, 0.76 0.004 Neurolog. Complic. 59 (2.7%) 6 (0.9%) 0.36 0.15, 0.85 0.02 Blood Loss (ml) 939.9 (512.3) 856.2 (582.1) −60.8 −111.7, −9.87 0.019 Total RBCs (unit) 1.05 (1.51) 0.436 (1.52) −0.51 −0.65, −0.37 0.0001 Total Platelets (unit) 0.24 (0.81) 0.08 (0.455) −0.157 −0.23, −0.08 0.0001 Total FFP (unit) 0.49 (1.48) 0.126 (0.72) −0.38 −0.5, −0.25 0.0001 Sternal rewiring 17 (0.78%) 1 (0.14%) −0.22 0.03, 1.7 0.15 Renal complications 98 (4.5%) 24 (3.56%) −0.74 0.44, 1.25 0.265 Hospital stay (day) 7.76 (4.26) 6.64 (3.04) −0.94 −1.39, −0.49 0.0001Conclusions: These results suggest that off‐pump surgery is safe, effective and associated with reduced morbidity in overweight patients.