Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission.

We evaluated the impact of intraoperative conversion from off-pump coronary artery bypass graft surgery (OPCAB) to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) on rates of postoperative 30-day hospital readmissions. Using data from the California CABG outcomes reporting program, postoperative 30-day hospital readmissions were compared among CCB, OPCAB, and intraoperative conversions from OPCAB to CCB (IOC) for isolated CABG operations. A multivariable logistic regression model with inverse propensity for OPCAB weighting was used to compute risk-adjusted readmission rates. General linear models were used to test the differences in propensity-weighted and risk-adjusted readmission rates among CCB, OPCAB, and IOC cases. Among 22,389 isolated CABGs, 5,125 (22.9%) were OPCAB; 595 (11.6%) OPCAB patients had intraoperative conversion from OPCAB to CCB (IOC). The patients who underwent IOC had a higher prevalence of preoperative heart failure, left main coronary artery disease, and 3 or greater diseased coronary vessels compared with OPCAB without conversion. The risk-adjusted readmission model (weighted for OPCAB propensity) showed OPCAB without conversion was not associated with any increase in readmission rates when compared with CCB (adjusted odds ratio [AOR]; 1.02, 95% confidence interval [CI], 0.963 to 1.081) but OPCAB with IOC had a significant effect on readmission (AOR, 1.258; 95% CI, 1.122 to 1.411, p<0.0001). The OPCAB with IOC was also associated with a higher proportion of readmissions due to postoperative infection (19.1% vs 11.9% of readmissions for CCB). Intraoperative conversions from OPCAB to CCB are associated with a higher rate of postoperative hospital readmission and infection.

Li Z ，Amsterdam EA ，Danielsen B ，Hoegh H ，Young JN ，Armstrong EJ ... -  《-》

Off-pump coronary artery bypass graft surgery in California, 2003 to 2005.

Li Z ，Yeo KK ，Parker JP ，Mahendra G ，Young JN ，Amsterdam EA ... -  《-》

Off-pump bypass surgery and postoperative stroke: California coronary bypass outcomes reporting program.

Coronary artery bypass surgery (CABG) is associated with a significant risk of stroke. Some studies suggest that off-pump CABG (OPCAB) may reduce postoperative stroke rate. We performed this study to evaluate the relationship between postoperative stroke and OPCAB compared with conventional on-pump CABG (CCB) in a recent, large cohort of patients. Data from the California CABG Outcomes Reporting Program were analyzed in patients who had OPCAB or CCB for isolated CABGs in 2006 to 2007. Two multivariable logistic regression models were developed for the analysis, and the "recycled predictions" method was used to compute risk-adjusted postoperative stroke rates in the two surgical groups. Of 30,426 isolated CABGs, 7,720 (23.7%) were OPCAB. The model developed in the CCB subset indicated that CCB had a lower predicted stroke risk than OPCAB, yet the observed rate of stroke was higher in the CCB subset. The model using both CCB and OPCAB patients revealed that OPCAB was associated with a reduction in postoperative stroke (adjusted odds ratio: 0.76, 95% confidence interval [CI] 0.59 to 0.98). For patients with cardiogenic shock, OPCAB was also associated with a lower risk-adjusted postoperative stroke rate compared with CCB (OPCAB: 3.06%, 95% CI 2.83% to 3.28%; CCB: 4.05%, 95% CI 3.76% to 4.33%, p < 0.001). However, the 793 (11%) OPCAB patients who were converted to CCB intraoperatively had an increased postoperative stroke rate (with conversion: 2.02%, 95% CI 1.04% to 3.00% versus without conversion: 0.96%, 95% CI 0.73% to 1.20%, p < 0.001). The OPCAB was associated with a significantly lower postoperative stroke rate compared with CCB even for older and higher risk patients. However, intraoperative OPCAB to CCB conversion was associated with the highest postoperative stroke rate.

Li Z ，Denton T ，Yeo KK ，Parker JP ，White R ，Young JN ，Amsterdam EA ... -  《-》

Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery.

Off-pump coronary artery bypass graft (OPCAB) may be associated with improved hospital outcomes compared with on-pump coronary artery bypass graft. However, intraoperative conversion to on-pump coronary artery bypass graft has been associated with adverse outcomes. The purpose of this study was to identify preoperative risk factors for intraoperative conversion in nonemergent patients undergoing isolated OPCAB. From 2002 to 2010, 8,077 consecutive OPCAB cases were performed at a single US academic center. Of these, 200 (2.5%) required intraoperative conversion. Standard variables from The Society of Thoracic Surgeons database were analyzed. A multivariable logistic model with adjusted odds ratios (OR) and 95% confidence intervals was used to identify independent risk factors for conversion. Adjusted in-hospital and long-term survival between converted and nonconverted patients were determined using multiple logistic regression and Cox proportional hazards regression, respectively. Converted patients had a higher Society of Thoracic Surgeons predicted risk of mortality (2.8% versus 2.1%; p<0.001). Surgeon identity was the most significant multivariable predictor of conversion. After adjustment for surgeon identity, the following independent risk factors were associated with intraoperative conversion: previous coronary artery bypass graft (OR, 3.43; p=0.018), congestive heart failure (OR, 1.51), myocardial infarction (OR, 1.86), number of grafts (OR, 1.45), left main disease (OR 1.41), and urgent status (OR, 1.77; all p<0.05). Conversion to on-pump coronary artery bypass graft was associated with increased in-hospital (OR, 4.8; p<0.001) and long-term mortality (hazard ratio, 1.65; p<0.001). Conversion to cardiopulmonary bypass during OPCAB is associated with increased in-hospital and long-term mortality and may be related to surgeon experience. Recognition of the preoperative risk factors associated with an increased risk of conversion may allow for better patient selection and reduce the incidence of intraoperative conversion during OPCAB.

Chowdhury R ，White D ，Kilgo P ，Puskas JD ，Thourani VH ，Chen EP ，Lattouf OM ，Cooper WA ，Myung RJ ，Guyton RA ，Halkos ME ... -  《-》

Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival.

Puskas JD ，Kilgo PD ，Lattouf OM ，Thourani VH ，Cooper WA ，Vassiliades TA ，Chen EP ，Vega JD ，Guyton RA ... -  《-》