Scott Bharathi H, Seifert Frank C, Grimson Roger, Glass Peter S A
Department of Anesthesiology, SUNY at Stony Brook, Health Sciences Center, Stony Brook, NY 11794-8480, USA.
J Cardiothorac Vasc Anesth. 2005 Feb;19(1):26-31. doi: 10.1053/j.jvca.2004.11.005.
The purpose of the present investigation was to examine factors influencing resource utilization in patients undergoing on-pump coronary artery bypass graft and off-pump coronary artery bypass (OPCAB) graft surgery at a major university hospital. The resources examined were time to extubation, packed red blood cell (PRBC) transfusion, intensive care length of stay (ICULOS), preoperative and postoperative length of stay (PLOS), and total length of stay (LOS).
Observational study of consecutive patients undergoing on- and off-pump coronary artery bypass surgery.
Tertiary care cardiac referral center.
One thousand seven hundred forty-six consecutive male and female patients undergoing primary coronary artery bypass graft (CABG) surgery over a period of 3 years (1999-2001). Eight hundred eighty-one patients underwent CABG with pump, and 865 patients underwent off-pump coronary artery bypass (OPCAB) surgery.
None.
The mean time to extubation after surgery was 7.4 hours for on-pump patients and 5.8 hours for the OPCAB group (p<or=0.001); 73.7% of patients on pump received PRBC transfusion as compared with 48.6% of the OPCAB group (p<or=0.001). The mean ICULOS for the on-pump group was 1.6 days and 1.4 days for the OPCAB group (p=0.006). PLOS was 6.5 days for the on-pump group and 5.6 days for the OPCAB group (p<or=0.001). Mean total LOS was 9.7 days for the on-pump group and 8.8 days for the OPCAB group (p<or=0.001). PLOS is correlated with several clinical and demographic ariables. Linear and logistic regression models were used to assess the effects of on/off pump on PLOS. Use of pump is significantly correlated with increased PLOS (p<or=0.001, Kendalls correlation), and pump use is strongly associated with transfusion (odds ratio=2.95, p<or=0.001), which in turn is a determinant of PLOS. There were no significant differences between the on- and off-pump groups in the incidence of postoperative complications except for bleeding requiring reexploration and ventilatory support for more than 72 hours. Incidence of bleeding was 3.3% in the on-pump group and 1.7% in the OPCAB group (p=0.038). In the on-pump group, 3% of patients required >72 hours to postoperative tracheal extubation compared with 1.5% in the OPCAB group (p=0.041). Hospital mortality was 2.7% for the on-pump group and 1.0% for the OPCAB group (p=0.010).
The authors found that patients undergoing on-pump CABG have significantly longer time to tracheal extubation, increased blood use, longer ICULOS, PLOS, and total LOS and higher in-hospital mortality, which would translate into significant differences in the expenses associated with these 2 surgical approaches to coronary surgery.
本研究旨在探讨在一所大型大学医院接受体外循环冠状动脉搭桥术和非体外循环冠状动脉搭桥术（OPCAB）的患者中影响资源利用的因素。所考察的资源包括拔管时间、浓缩红细胞（PRBC）输注情况、重症监护病房住院时间（ICULOS）、术前和术后住院时间（PLOS）以及总住院时间（LOS）。
对连续接受体外循环和非体外循环冠状动脉搭桥手术的患者进行观察性研究。
三级心脏转诊中心。
在3年期间（1999 - 2001年）连续1746例接受初次冠状动脉搭桥术（CABG）的男性和女性患者。881例患者接受体外循环CABG，865例患者接受非体外循环冠状动脉搭桥术（OPCAB）。
无。
体外循环患者术后平均拔管时间为7.4小时，OPCAB组为5.8小时（p≤0.001）；体外循环患者中73.7%接受了PRBC输注，而OPCAB组为48.6%（p≤0.001）。体外循环组的平均ICULOS为1.6天，OPCAB组为1.4天（p = 0.006）。体外循环组的PLOS为6.5天，OPCAB组为5.6天（p≤0.001）。体外循环组的平均总住院时间为9.7天，OPCAB组为8.8天（p≤0.001）。PLOS与多个临床和人口统计学变量相关。使用线性和逻辑回归模型评估体外循环/非体外循环对PLOS的影响。体外循环的使用与PLOS增加显著相关（p≤0.001，肯德尔相关性），并且体外循环的使用与输血密切相关（优势比 = 2.95，p≤0.001），而输血又是PLOS的一个决定因素。除了需要再次手术探查的出血和需要超过72小时的通气支持外，体外循环组和非体外循环组术后并发症的发生率没有显著差异。体外循环组的出血发生率为3.3%，OPCAB组为1.7%（p = 0.038）。在体外循环组中，3%的患者术后气管拔管需要超过72小时，而OPCAB组为1.5%（p = 0.041）。体外循环组的医院死亡率为2.7%，OPCAB组为1.0%（p = 0.010）。
作者发现接受体外循环CABG的患者气管拔管时间显著更长、用血增加、ICULOS、PLOS和总住院时间更长且院内死亡率更高，这将导致这两种冠状动脉手术方法相关费用存在显著差异。
