Aim
The aim of this study was to assess the impact of surgeon experience and centre volume
on early operative outcomes in patients undergoing off-pump coronary artery bypass
(OPCAB) surgery.
Method
Of 7,352 patients in the European Multicenter Study on Coronary Artery Bypass Grafting
(E-CABG) registry, 1,549 underwent OPCAB and were included in the present analysis.
Using adjusted regression analysis, we compared major early adverse events after procedures
performed by experienced OPCAB surgeons (i.e., ≥20 cases per year; n=1,201) to those
performed by non-OPCAB surgeons (n=348). Furthermore, the same end points were compared
between procedures performed by OPCAB surgeons in high OPCAB volume centres (off-pump
technique used in >50% of cases; n=894) and low OPCAB volume centres (n=307).
Results
In the experienced OPCAB surgeon group, we observed shorter procedure times (β –43.858,
95% confidence interval [CI] –53.322 to –34.393; p<0.001), a lower rate of conversion
to cardiopulmonary bypass (odds ratio [OR] 0.284, 95% CI 0.147–0.551; p<0.001), a
lower rate of prolonged inotrope or vasoconstrictor use (OR 0.492, 95% CI 0.371–0.653;
p<0.001), a lower rate of early postprocedural percutaneous coronary interventions
(OR 0.335, 95% CI 0.169–0.663; p=0.002), and lower 30-day mortality (OR 0.423, 95%
CI 0.194–0.924; p=0.031). In high OPCAB volume centres, we found a lower rate of prolonged
inotrope use (OR 0.584, 95% CI 0.419–0.814; p=0.002), a lower rate of postprocedural
acute kidney injury (OR 0.382, 95% CI 0.198–0.738; p=0.004), shorter duration of intensive
care unit (β –1.752, 95% CI –2.240 to –1.264; p<0.001) and hospital (β –1.967; 95%
CI –2.717 to –1.216; p<0.001) stays, and lower 30-day mortality (OR 0.316, 95% CI
0.114–0.881; p=0.028).
Conclusions
Surgeon experience and centre volume may play an important role on the early outcomes
after OPCAB surgery.
Keywords
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Article info
Publication history
Published online: December 22, 2022
Accepted:
November 20,
2022
Received in revised form:
September 17,
2022
Received:
June 28,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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