A retrospective comparison of on- and off-pump coronary artery bypass surgery undergoing fast track protocol

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 34; p. S39
• Main Authors: Grützner, H., Forner, A. Flo, Ender, J., Zakhary, W.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2020
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2020.09.054

Fast track treatment, especially in a specialized recovery area, is a safe alternative for patients with low to moderate risk after surgery and leads to a reduced ventilation time as well as a shorter stay in the intensive care unit especially.1The benefit of fast track in off-pump vs on-pump coronary artery bypass patients is unclear.
The aim of the study was the comparison of on- vs off-pump coronary artery bypass surgery undergoing fast track protocol. Primary endpoints are ventilation time and primary fast track failure. Primary fast track failure is defined as unplanned transfer from the recovery area to the intensive care unit or back to the operating theatre. Secondary endpoints include length of stay in recovery area, intermediate care unit and hospital, postoperative complications and secondary fast track failure (patients transferred from intermediate care or ward back to the intensive or intermediate care unit).
This retrospective observational study was performed in a single centre heart centre. Between September 2012 and December 2018 n= 3505 consecutive patients after coronary artery bypass surgery underwent fast track protocol. Patients after on-pump coronary artery bypass surgery were compared with patients after off-pump coronary artery bypass surgery using propensity score matching. Matching criteria included: age, gender, BMI, logistic Euroscore, preoperative ejection fraction, co-existing diseases, operative time and risk factors.
Values are expressed as percentage or mean value ± standard deviation.
After propensity score matching 926 patients were included in each group. There were no significant differences in demographic data after matching. Time to extubation showed no significant difference between both groups (on-pump 75 (55-120) min vs off-pump 80 (55-120) min, p=0,973). Primary and secondary fast track failure were also not significantly different between the groups with 8.2% vs 6 % and 12.9% vs 12.3% in on-pump vs off-pump group. There were no significant differences between both groups in terms of postanaesthetic care length of stay (on-pump 265 (83) min vs off-pump 270 (85) min, p=0,702), intermediate care length of stay (on-pump 53,6 (56) h vs off-pump 50 (56) h, p=0,316) and hospital length of stay (on-pump 9,9 (5,3) d vs off-pump 9,6 (5,4) d, p=0,256). Postoperative complications were comparable except for a significant difference in postoperative bleeding. Patients receiving off-pump coronary artery bypass surgery had a significant (p<0,0001) higher postoperative blood loss (323 (247) ml) compared to patients after on-pump coronary artery bypass surgery (234 (243) ml), however we do not consider the difference clinically significant.
In conclusion, on- and off-pump coronary artery bypass surgery seem to be comparable in terms of fast track success. Any difference between the two approaches may be only attributed to the difference in the preoperative risk profile and length of surgery.