Off-pump surgery decreases postoperative complications and resource utilization in the elderly
Off-pump surgery decreases postoperative complications and resource utilization in the elderly
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DOI：
10.1016/s0003-4975(99)00951-0
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发表时间：
1999-10-01
影响因子：
4.6
通讯作者：
Menkis, AH
中科院分区：
文献类型：
--
作者：
Boyd, WD;Desai, ND;Menkis, AH
背景资料。老年人(70岁)的搭桥手术增加了死亡率和发病率，这可能是体外循环的结果。我们比较了一组老年非体外循环冠状动脉旁路移植术(OPCAB)患者和老年常规冠状动脉旁路移植术(CABG)患者的结果。回顾了30例连续的老年OPCAB患者(年龄74.7+/-4.2岁)和60例连续的CABG患者(年龄74.9+/-4.1岁，p=0.82)的图表和省级心脏护理登记数据：Parsonnet评分17.2+/-8.1(OPCAB)对15.6+/-6.5(CABG)，p=0.31；安大略省视力指数4.5+/-1.9(OPCAB)对4.3+/-2.0(CABG)，p=0.65。平均住院天数OPCAB组为6.3±1.8天，CABG组7.7±3.9天(p<；0.05)，重症监护病房平均住院时间OPCAB组为24.0±10.9 h，CABG组为36.6±33.5 h(p<；0.05)。OPCAB组和CABG组的房颤发生率分别为10.0%和28.3%(p<；0.05)。OPCAB组和CABG组低输出量综合征发生率分别为10%和31.7%(p<；0.05)。OPCAB组每个患者的费用降低了1082美元(加拿大)。术后OPCAB移植物分析显示100%通畅。OPCAB在老年人群中是安全的，并显著降低了术后发病率和成本。(C)1999年，由胸外科医生学会颁发。
Background. Bypass surgery in the elderly (age >70 years) has increased mortality and morbidity, which may be a consequence of cardiopulmonary bypass. We compare the outcomes of a cohort of elderly off-pump coronary artery bypass (OPCAB) patients with elderly conventional coronary artery bypass grafting (CABG) patients.Methods. Chart and provincial cardiac care registry data were reviewed for 30 consecutive elderly OPCAB patients (age 74.7 +/- 4.2 years) and 60 consecutive CABG patients (age 74.9 +/- 4.1 years, p = 0.82) with similar risk factor profiles: Parsonnet score 17.2 +/- 8.1 (OPCAB) versus 15.6 +/- 6.5 (CABG), p = 0.31; and Ontario provincial acuity index 4.5 +/- 1.9 (OPCAB) versus 4.3 +/- 2.0 (CABG), p = 0.65.Results. Mean hospital stay was 6.3 +/- 1.8 days for OPCAB patients and 7.7 +/- 3.9 days for CABG patients (p < 0.05), Average intensive care unit stay was 24.0 +/- 10.9 h for OPCAB patients versus 36.6 +/- 33.5 h for CABG patients (p < 0.05). Atrial fibrillation occurred in 10.0% of OPCAB patients and 28.3% of CABG patients (p < 0.05). Low output syndrome was observed in 10% of OPCAB patients and 31.7% of CABG patients (p < 0.05). Cost was reduced by $1,082 (Canadian) per patient in the OPCAB group. Postoperative OPCAB graft analysis showed 100% patency.Conclusions. OPCAB is safe in the geriatric population and significantly reduces postoperative morbidity and cost. (C) 1999 by The Society of Thoracic Surgeons.