Off-pump surgery decreases postoperative complications and resource utilization in the elderly

Background. Bypass surgery in the elderly (age >70 years) has increased mor tality and morbidity, which may be a consequence of cardiopulmonary bypass. We compare the outcomes of a cohort of elderly off-pump coronary artery by pass (OPCAB) patients with elderly conventional coronary artery bypass graf ting (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 conse cutive CABG patients (age 74.9 +/- 4.1 years, p = 0.82) with similar risk f actor profiles: Parsonnet score 17.2 +/- 8.1 (OPCAB) versus 15.6 +/- 6.5 (C ABG), p = 0.31; and Ontario provincial acuity index 4.5 +/- 1.9 (OPCAB) ver sus 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 sta y was 24.0 +/- 10.9 h for OPCAB patients versus 36.6 +/- 33.5 h for CABG pa tients (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 reduc ed 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 re duces postoperative morbidity and cost. (C) 1999 by The Society of Thoracic Surgeons.