Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results From the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry

被引：8

作者：

Naito, Shiho ^{[1
]}

Demal, Till J. ^{[1
]}

Sill, Bjoern ^{[1
]}

Reichenspurner, Hermann ^{[1
]}

Onorati, Francesco ^{[2
]}

Gatti, Giuseppe ^{[3
]}

Mariscalco, Giovanni ^{[4
]}

Faggian, Giuseppe ^{[3
]}

Salsano, Antonio ^{[5
,6
]}

Santini, Francesco ^{[5
,6
]}

Santarpino, Giuseppe ^{[7
,8
,9
]}

Zanobini, Marco ^{[10
]}

Musumeci, Francesco ^{[11
]}

Rubino, Antonino S. ^{[12
,13
]}

Bancone, Ciro ^{[14
]}

De Feo, Marisa ^{[14
]}

Nicolini, Francesco ^{[15
]}

Dalen, Magnus ^{[16
]}

Speziale, Giuseppe ^{[17
]}

Bounader, Karl ^{[18
]}

Maekikallio, Timo ^{[19
,20
]}

Tauriainen, Tuomas ^{[20
]}

Ruggieri, Vito G. ^{[21
]}

Perrotti, Andrea ^{[22
]}

Biancari, Fausto ^{[20
,23
,24
,25
]}

机构：

[1] Univ Heart & Vasc Ctr Hamburg, Dept Cardiovasc Surg, Hamburg, Germany

[2] Verona Univ Hosp, Dept Cardiac Surg, Verona, Italy

[3] Trieste Univ Hosp, Cardiothorac & Vasc Dept, Trieste, Italy

[4] Univ Hosp Leicester NHS Trust, Glenfield Hosp, Dept Cardiovasc Sci, Leicester, Leics, England

[5] Univ Genoa, IRCCS Osped Policlin San Martino, Div Cardiac Surg, Genoa, Italy

[6] Univ Genoa, DISC Dept, Genoa, Italy

[7] Magna Graecia Univ Catanzaro, Dept Clin & Expt Med, Catanzaro, Italy

[8] Citta Lecce Hosp GVM, Dept Cardiac Surg, GVM Lecce, Lecce, Italy

[9] Paracelsus Med Univ, Dept Cardiac Surg, Klinikum Nurnberg, Nurnberg, Germany

[10] Fdn Monzino IRCCS, Ctr Cardiol, Dept Cardiac Surg, Milan, Italy

[11] Hosp S Camillo Forlanini, Dept Cardiosci, Unit Cardiac Surg, Rome, Italy

[12] Ctr Cuore, Dept Cardiac Surg, Pedara, Italy

[13] Papardo Hosp, Cardio Thoraco Vasc Dept, Div Cardiac Surg, Messina, Italy

[14] Univ Campania Luigi Vanvitelli, Dept Cardiothorac Sci, Naples, Italy

[15] Univ Parma, Cardiac Surg Unit, Parma, Italy

[16] Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, Dept Cardiothorac Surg, Stockholm, Sweden

[17] Anthea Hosp, GVM Care & Res, Dept Cardiac Surg, Bari, Italy

[18] Pontchaillou Univ Hosp, Div Cardiothorac & Vasc Surg, Rennes, France

[19] Univ Helsinki, South Karelja Cent Hosp, Dept Med, Helsinki, Finland

[20] Oulu Univ Hosp, Dept Internal Med, Oulu, Finland

[21] Univ Reims, Robert Debre Univ Hosp, Div Cardiothorac & Vasc Surg, Reims, France

[22] Univ Hosp Jean Minjoz, Dept Thorac & Cardiovasc Surg, Besancon, France

[23] GVM Care & Res, Dept Clin Montevergine, Mercogliano, Italy

[24] Helsinki Univ Hosp, Dept Heart, Helsinki, Finland

[25] Helsinki Univ Hosp, Lung Ctr, Helsinki, Finland

来源：

HEART LUNG AND CIRCULATION | 2023年 / 32卷 / 03期

关键词：

Off-pump coronary bypass; Individual surgeon; Surgeon volume; Centre volume; ON-PUMP; 5-YEAR OUTCOMES; HIGH-RISK; CONVERSION; OPCAB;

D O I：

10.1016/j.hlc.2022.11.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (I3 -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 in-terventions (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 (I3 -1.752, 95% CI -2.240 to -1.264; p<0.001) and hospital (I3 -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.

引用

页码：387 / 394

页数：8

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