Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials

• Published in: Anesthesiology (Philadelphia) Vol. 102; no. 1; pp. 188 - 203
• Main Authors: CHENG, Davy C, BAINBRIDGE, Daniel, MARTIN, Janet E, NOVICK, Richard J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 2005
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - economics; Coronary Artery Bypass - mortality; Coronary Artery Bypass, Off-Pump; Data Interpretation, Statistical; Endpoint Determination; Extracorporeal Circulation - adverse effects; Extracorporeal Circulation - economics; Extracorporeal Circulation - mortality; Humans; Medical sciences; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative Complications - psychology; Quality of Life; Randomized Controlled Trials as Topic; Resource Allocation; Treatment Outcome; Anesthesia; Bypass; Mortality; Morbidity; Coronary artery
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-200501000-00028

The authors undertook a meta-analysis of 37 randomized trials (3369 patients) of off-pump coronary artery bypass surgery versus conventional coronary artery bypass surgery. No significant differences were found for 30-day mortality (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.58-1.80), myocardial infarction (OR, 0.77; 95%CI, 0.48-1.26), stroke (OR, 0.68; 95%CI, 0.33-1.40), renal dysfunction, intraaortic balloon pump, wound infection, rethoracotomy, or reintervention. However, off-pump coronary artery bypass surgery significantly decreased atrial fibrillation (OR, 0.58; 95%CI, 0.44-0.77), transfusion (OR, 0.43; 95%CI, 0.29-0.65), inotrope requirements (OR, 0.48; 95%CI, 0.32-0.73), respiratory infections (OR, 0.41; 95%CI, 0.23-0.74), ventilation time (weighted mean difference, -3.4 h; 95%CI, -5.1 to -1.7 h), intensive care unit stay (weighted mean difference, -0.3 days; 95%CI -0.6 to -0.1 days), and hospital stay (weighted mean difference, -1.0 days; 95%CI -1.5 to -0.5 days). Patency and neurocognitive function results were inconclusive. In-hospital and 1-yr direct costs were generally higher for conventional coronary artery bypass surgery versus off-pump coronary artery bypass surgery. Therefore, this meta-analysis demonstrates that mortality, stroke, myocardial infarction, and renal failure were not reduced in off-pump coronary artery bypass surgery surgery; however, selected short-term and mid-term clinical and resource outcomes were improved compared with conventional coronary artery bypass surgery.