Hravnak Marilyn, Hoffman Leslie A, Saul Melissa I, Zullo Thomas G, Cuneo Julie F, Pellegrini Ronald V
Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pa., USA.
Am J Crit Care. 2004 Nov;13(6):499-507; discussion 508.
Studies suggest that patients who undergo off-pump coronary artery bypass grafting (OPCABG) have fewer short-term complications and use fewer inpatient resources than do patients who undergo standard coronary artery bypass grafting (CABG) with extracorporeal circulation. However, dissimilarity between groups in risk factors for complications has hindered interpretation of results.
To compare the prevalence of selected complications (atrial fibrillation, stroke, reoperation, and bleeding) and inpatient resource utilization (length of stay, discharge disposition, total charges) between subjects undergoing primary isolated CABG or OPCABG who were matched with respect to key risk factors.
Retrospective, causal-comparative survey conducted in 1 center for 18 months. Patients who underwent primary isolated CABG or OPCABG were matched for sex, age (within 2 years), left ventricular ejection fraction (within 0.05), and graft-patient ratio (exact match) and compared for prevalence of new-onset atrial fibrillation, stroke, reoperation within 24 hours, and bleeding. Statistical analysis included Wilcoxon and t tests for paired comparisons.
The sample (107 matched pairs) was 63% male, with a mean age of 66 (SD 9.5) years, a mean left ventricular ejection fraction of 0.51 (SD 0.13), and a mean graft-patient ratio of 3.41 (SD 0.74). The 2 groups did not differ significantly in New York Heart Association class (P = .43), Acute Physiology and Chronic Health Evaluation III score (P = .22), postoperative beta-blocker use (P = .73), or comorbid conditions. None of the complications examined differed significantly between pairs.
Patients with comparable risk profiles have similar prevalences of selected complications after CABG and OPCABG.
研究表明，与接受体外循环标准冠状动脉旁路移植术（CABG）的患者相比，接受非体外循环冠状动脉旁路移植术（OPCABG）的患者短期并发症更少，住院资源使用也更少。然而，两组并发症危险因素的差异阻碍了对结果的解读。
比较在关键危险因素方面相匹配的接受初次单纯CABG或OPCABG的受试者中选定并发症（心房颤动、中风、再次手术和出血）的发生率以及住院资源利用情况（住院时间、出院处置、总费用）。
在1个中心进行了为期18个月的回顾性、因果比较调查。对接受初次单纯CABG或OPCABG的患者按性别、年龄（2年内）、左心室射血分数（0.05以内）和移植物与患者比例（精确匹配）进行匹配，并比较新发心房颤动、中风、24小时内再次手术和出血的发生率。统计分析包括用于配对比较的Wilcoxon检验和t检验。
样本（107对匹配病例）中男性占63%，平均年龄66（标准差9.5）岁，平均左心室射血分数0.51（标准差0.13），平均移植物与患者比例3.41（标准差0.74）。两组在纽约心脏协会分级（P = 0.43）、急性生理与慢性健康状况评估III评分（P = 0.22）、术后β受体阻滞剂使用情况（P = 0.73）或合并症方面无显著差异。所检查的并发症在配对病例之间均无显著差异。
具有可比风险特征的患者在CABG和OPCABG术后选定并发症的发生率相似。
