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Eur J Cardiothorac Surg 2002;22:255-260
© 2002 Elsevier Science NL

The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity

N.C. Patela,b, A.D. Graysona,b, M. Jacksona,b, J. Auc, N. Yonand, R. Hasane, B.M. Fabria,b* on behalf of the North West Quality Improvement Programme in Cardiac Interventions

a Department of Cardiothoracic Surgery, The Cardiothoracic Centre – Liverpool, Thomas Drive, Liverpool L14 3PE, UK
b Department of Clinical Audit, The Cardiothoracic Centre – Liverpool, Thomas Drive, Liverpool L14 3PE, UK
c Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK
d Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
e Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK

Received 3 January 2002; received in revised form 14 May 2002; accepted 17 May 2002.

* Corresponding author. Tel.: +44-151-293-2397; fax: +44-151-220-8573
e-mail: bfabr{at}ccl-tr.nwest.nhs.uk

Objective: Off-pump coronary artery bypass (OPCAB) surgery is being increasingly reported to show better outcomes compared to conventional on bypass grafting. We examined the effect of OPCAB on in-hospital mortality and morbidity, while adjusting for patient and disease characteristics, in four institutions in the North West of England. Methods: Between April 1997 and March 2001, 10 941 consecutive patients underwent isolated coronary artery bypass surgery at these four institutions. Of these, 7.7% were performed off-pump. We used logistic regression to examine the effect of OPCAB on in-hospital mortality and morbidity after adjusting for potentially confounding variables. Results: The crude odds ratio (OR) for death (off-pump versus on-pump coronary bypass grafting) was 0.48 (95% confidence interval, CI 0.26–0.92; P=0.023). After adjustment for all major risk factors, the OR for death was 0.59 (95% CI 0.31–1.12; P=0.105). Off-pump patients had a substantially reduced risk of post-operative stroke (0.6 versus 2.3%, respectively; adjusted OR 0.26 (95% CI 0.09–0.70; P=0.008) and a significant reduction in post-operative hospital stay. Other morbidity outcomes were similar in both groups. Conclusions: Off-pump coronary artery bypass incurs no increased risk of in-hospital mortality. In contrast, there is a significant reduction in morbidity in patients undergoing off-pump coronary bypass grafting when compared to that performed on cardiopulmonary bypass.

Key Words: Off-pump • Coronary artery bypass • Mortality • Morbidity • Risk adjustment




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Copyright © 2002 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.