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.
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).
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).
Surgeon experience and centre volume may play an important role on the early outcomes after OPCAB surgery.
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- Impact of center volume on outcomes of surgical repair for type A acute aortic dissections.Surgery. 2020; 168: 185-192
- Meta-analysis of hospital-volume relationship in transcatheter aortic valve implantation.Heart Lung Circ. 2020; 29: e147-e156
- The relation between surgeon volume and outcome following off-pump vs on-pump coronary artery bypass graft surgery.Chest. 2005; 128: 829-837
- High OPCAB surgical volume improves midterm event-free survival.Heart Surg Forum. 2009; 12: E250-E255
- Exploring the volume–outcome relationship for off-pump coronary artery bypass graft procedures.Ann Thorac Surg. 2006; 81: 547-553
- Comparing clinical outcomes in high-volume and low-volume off-pump coronary bypass operation programs.Ann Thorac Surg. 2001; 72: S1009-S1015
- Maryland’s global budget revenue program and coronary artery bypass surgery.Ann Thorac Surg. 2020; 110: 592-597
- Neurological complications in high-risk patients undergoing coronary artery bypass surgery.Ann Thorac Surg. 2022; 113: 1514-1520
- Coronary artery bypass grafting in patients with high risk of bleeding.Heart Lung Circ. 2022; 31: 263-271
- European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG registry): study protocol for a prospective clinical registry and proposal of classification of postoperative complications.J Cardiothorac Surg. 2015; 10: 90
- KDIGO clinical practice guidelines for acute kidney injury.Nephron. 2012; 120: c179-c184
- On-pump versus off-pump coronary-artery bypass.N Engl J Med. 2009; 360: 2605-2615
- Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting.N Engl J Med. 2016; 375: 2359-2368
- Off-pump versus on-pump coronary-artery bypass grafting in elderly patients.N Engl J Med. 2013; 368: 1189-1198
- Effect of hospital and surgeon procedure volumes on the incidence of intraoperative conversion during off-pump coronary artery bypass grafting.Semin Thorac Cardiovasc Surg. 2021; 33: 49-58
- Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial.Eur J Cardiothorac Surg. 2005; 27: 296-301
- Outcomes after conversion in the Veterans Affairs randomized on versus off bypass trial.Ann Thorac Surg. 2011; 92: 2147-2154
- On-pump versus off-pump CABG.N Engl J Med. 2010; 362: 851-854
- Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: insights from the Arterial Revascularization Trial.J Thorac Cardiovasc Surg. 2021; 162: 591-599
- 2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J. 2019; 40: 87-165
- Five-year outcomes after on-pump and off-pump coronary-artery bypass.N Engl J Med. 2017; 377: 623-632
- Comparison of outcomes for off-pump versus on-pump coronary artery bypass grafting in low-volume and high-volume centers and by low-volume and high-volume surgeons.Am J Cardiol. 2018; 121: 552-557
Published online: December 22, 2022
Accepted: November 20, 2022
Received in revised form: September 17, 2022
Received: June 28, 2022
© 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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