Original article: cardiovascularConversion in Off-Pump coronary artery bypass grafting: an analysis of predictors and outcomes
Section snippets
Patients
Data on a total of 4,689 patients were exported from our Society of Thoracic Surgeons (STS) approved database. These data represented the population of all isolated CABG patients operated on by our group of 22 surgeons from January 1, 2000, to June 30, 2002. Patients whose status was listed as “emergent” or “salvage”, who were in cardiogenic shock, or who were being resuscitated were not included in the study, reasoning that they could only be done on-pump. This excluded a total of 151 patients
Results
The overall conversion rate was 3.71% but the rate varied between groups. Surgeons with a high prior volume of OPCAB cases had a rate of 1.85%, which was statistically lower than the rate for low-volume surgeons (7.13%, p < 0.001) or that recorded for moderate-volume surgeons (4.3%, p = 0.02; Table 1).
Overall, patients converted to ONCAB had a significantly higher mortality rate than computer-matched patients whose procedure was initiated as ONCAB (18% versus 2.7%, p < 0.001). Mortality rates
Comment
Several other studies have addressed the incidence of mortality among converted patients, usually comparing the converted patients with patients who were not converted 5, 6, 7, 8, 9. We sought to determine whether patients started off-pump and converted to on-pump fared less well than if their procedure had been initiated as on- pump. For this reason we compared our converted patients with a computer-derived comparable cohort of patients whose procedure was initiated as ONCAB and who had not
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The management of perioperative ischemia
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2019, Annals of Thoracic SurgeryOff-Pump Versus On-Pump: Long-Term Outcomes After Coronary Artery Bypass in a Veteran Population
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Another guiding philosophy is that the patient should undergo the same surgery, whether on-pump or off-pump. Intraoperative conversion electively to address a particularly challenging target vessel is not associated with worse outcomes, and this is distinct from urgent or emergency conversions for hemodynamic instability.12 The conversion rate was not tracked specifically in this study because the goal was to evaluate long-term outcomes after either on-pump or off-pump surgery, but in a previous study in an overlapping patient population evaluating short-term outcomes, the authors found an urgent/emergent conversion rate of 0.8% and an elective conversion rate of 7%.
Effect of Hospital and Surgeon Procedure Volumes on the Incidence of Intraoperative Conversion During Off-Pump Coronary Artery Bypass Grafting
2021, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Second, the impact of surgeon volume on the incidence of conversion is limited in hospitals within the same hospital CABG volume categories. Previous studies have reported that limited surgeon experience is a significant risk factor for intraoperative conversion even after risk adjustment.8,10,19 However, all of these studies failed to adjust for hospital procedure volume as a confounding factor.