Elsevier

The Annals of Thoracic Surgery

Volume 84, Issue 5, November 2007, Pages 1447-1456
The Annals of Thoracic Surgery

J. Maxwell Chamberlain memorial paper for adult cardiac surgery
Off-Pump Techniques Benefit Men and Women and Narrow the Disparity in Mortality After Coronary Bypass Grafting

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007. Winner of the J. Maxwell Chamberlain Memorial Award for Adult Cardiac Surgery
https://doi.org/10.1016/j.athoracsur.2007.06.104Get rights and content

Background

Women have historically had greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (ONCAB). It is controversial whether off-pump CABG (OPCAB) alters this gender-based disparity.

Methods

The Society of Thoracic Surgeons National Cardiac Database was reviewed for risk factors and clinical outcomes of 42,477 consecutive, nonemergency, isolated, primary ONCAB or OPCAB cases performed at 63 North American centers that performed more than 100 OPCAB cases between January 1, 2004, and December 31, 2005. Odds ratios for adverse events, adjusted for 32 clinical and demographic covariates, were compared by multiple logistic regression models between women and men who had OPCAB versus ONCAB. All analyses were by intention-to-treat; 355 (2.2%) patients converted from OPCAB to ONCAB intraoperatively were included in the OPCAB group.

Results

Women (n = 11,785) and those treated with OPCAB (n = 16,245) were older and had more comorbidities than men (n = 30,662) and those treated with conventional ONCAB (n = 26,202). Overall, adjusted odds ratios for death and most major complications in both men and women were significantly lower with OPCAB than with ONCAB. Among ONCAB cases only, women had a significantly greater adjusted risk of death, prolonged ventilation, and long length of stay than men. In contrast, among OPCAB cases, women had lower risk of reexploration than men and similar risks for death, myocardial infarction, and prolonged ventilation and hospital stay.

Conclusions

OPCAB is associated with lower adjusted risk of death and major adverse events than ONCAB. OPCAB benefits both men and women and reduces the gender disparity in clinical outcomes after CABG.

Section snippets

Study Design

This retrospective, intention-to-treat, cohort study was conducted in compliance with federal regulations, the Declaration of Helsinki, and Institutional Review Board (IRB) standards. A national sample was gathered after a Request for Data Access application to the STS. Among 663 participating sites, the STS National Cardiac Database (version 2.52) was reviewed for risk factors and clinical outcomes of 42,477 consecutive, nonemergency, isolated, primary ONCAB or OPCAB cases performed at those

Preoperative Characteristics

Table 1 lists patient characteristics and risk factors for each combination of gender and surgery type within the population of 42,477 consecutive patients. The 11,785 women in the study were significantly older (67.0 versus 64.1, p < 0.001) and had more comorbidities and a higher STS predicted risk [21] of mortality (3.0%) than the 30,662 men (predicted risk 1.7%; p < 0.001). The 16,245 patients treated with OPCAB were older (65.6 versus 64.5 years, p < 0.001) than the 26,202 patients treated

Comment

This retrospective review of the STS National Adult Cardiac Database analyzed preoperative risk factors and postoperative outcomes for 42,477 consecutive patients who underwent nonemergency, isolated, primary CABG from January 1, 2004, through December 31, 2005. This data sample was limited to 63 institutions that were reasonably experienced in both off-pump and on-pump CABG and included consecutive cases performed since the introduction of a data field recording intraoperative conversion of

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