Outcomes after usage of a quality initiative program for off-pump coronary artery bypass surgery: A comparison with on-pump surgery

被引:17
作者
Gobran, SR
Goldman, S
Ferdinand, F
Wertan, MA
Trace, C
Grunkemeier, GL
Wu, YX
Sutter, FP
机构
[1] Lankenau Hosp, Dept Cardiothorac Surg, Main Line Hlth Syst, Wynnewood, PA USA
[2] Christina Care Hlth Serv, Dept Anesthesia, Wilmington, DE USA
[3] Providence Hlth Syst, Portland, OR USA
关键词
D O I
10.1016/j.athoracsur.2004.05.084
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Off-pump coronary artery bypass (OPCAB) may be associated with improved outcomes when compared with on-pump coronary artery bypass. This study evaluates the use of a system for access and stabilization (SAS) with a coronary stabilizer as well as a clinical effectiveness quality initiative (CEQI) process regarding outcomes. This included the development of an expanded heart care team as well as standardization and refinement of perioperative care at The Lankenau Hospital (ILH). Our aim was to evaluate morbidity and mortality of on-pump coronary artery bypass grafting (CABG) compared with OPCAB surgery using SAS in addition to a CEQI initiative. Methods. A retrospective consecutive cohort study using the Society of Thoracic Surgery (STS) National Database was conducted. Three cohorts were analyzed: pre-SAS (December 1, 1999-August 31, 2000); use of SAS only (September 1, 2000-April 30, 2001), and the use of SAS + CEQI process (May 1, 2001-September 30, 2002). Morbidity and mortality for all on-pump CABG procedures performed over the time period of December 1, 1999-September 30, 2002 were compared with the SAS and SAS + CEQI groups only. Results. One-thousand two-hundred sixty-seven procedures were performed; 405 on-pump CABGs, 90 OPCABs pre-SAS, and 772 OPCABs with SAS, of which 552 were in the SAS + CEQI group. Statistically mortality was significantly lower in the SAS + CEQI vs the on-pump group (0.7% vs 3.0%, p < 0.01). The percentage of patients with prolonged ventilation was significantly lower statistically in the SAS + CEQI vs the on-pump group (4.2% vs 9.7%, p < 0.01). Statistically the length of stay was significantly lower in both SAS groups compared with the on-pump group (p < 0.01). Conclusions. OPCAB surgery using SAS in conjunction with a CEQI initiative improves outcomes for patients compared with on-pump CABG surgery. (C) 2004 by The Society of Thoracic Surgeons.
引用
收藏
页码:2015 / 2021
页数:7
相关论文
共 16 条
[1]   Integrated approach to off-pump coronary artery bypass surgery [J].
Al-Ruzzeh, S ;
Amrani, M ;
Boscoe, M ;
Farrimond, J ;
Riedel, B ;
Wright, I ;
George, S .
CARDIOVASCULAR SURGERY, 2003, 11 (04) :299-303
[2]   Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials [J].
Angelini, GD ;
Taylor, FC ;
Reeves, BC ;
Ascione, R .
LANCET, 2002, 359 (9313) :1194-1199
[3]   Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity [J].
Cleveland, JC ;
Shroyer, ALW ;
Chen, AY ;
Peterson, E ;
Grover, FL .
ANNALS OF THORACIC SURGERY, 2001, 72 (04) :1282-1288
[4]   DOES ROUTINE USE OF AORTIC ULTRASONOGRAPHY DECREASE THE STROKE RATE IN CORONARY-ARTERY BYPASS-SURGERY [J].
DUDA, AM ;
LETWIN, LB ;
SUTTER, FP ;
GOLDMAN, SM ;
WALKER, PM ;
NICHOLAS, GG ;
GRANKEY, K ;
FOGARTY, TJ .
JOURNAL OF VASCULAR SURGERY, 1995, 21 (01) :98-109
[5]  
EDMUNDS LHJ, 1997, CARDIAC SURG ADULT, P278
[6]   Cumulative sum techniques for assessing surgical results [J].
Grunkemeier, GL ;
Wu, YX ;
Furnary, AP .
ANNALS OF THORACIC SURGERY, 2003, 76 (03) :663-667
[7]   Improved outcomes in coronary artery bypass grafting with beating-heart techniques [J].
Mack, M ;
Bachand, D ;
Acuff, T ;
Edgerton, J ;
Prince, S ;
Dewey, T ;
Magee, M .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2002, 124 (03) :598-607
[8]   Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients [J].
Magee, MJ ;
Jablonski, KA ;
Stamou, SC ;
Pfister, AJ ;
Dewey, TM ;
Dullum, MKC ;
Edgerton, JR ;
Prince, SL ;
Acuff, TE ;
Corso, PJ ;
Mack, MJ .
ANNALS OF THORACIC SURGERY, 2002, 73 (04) :1196-1202
[9]   A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients [J].
Nathoe, HM ;
van Dijk, D ;
Jansen, EWL ;
Suyker, WJL ;
Diephuis, JC ;
van Boven, WJ ;
de la Rivière, AB ;
Borst, C ;
Kalkman, CJ ;
Grobbee, DE ;
Buskens, E ;
de Jaegere, PPT .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (05) :394-402
[10]   Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes [J].
Plomondon, ME ;
Cleveland, JC ;
Ludwig, ST ;
Grunwald, GK ;
Kiefe, CI ;
Grover, FL ;
Shroyer, AL .
ANNALS OF THORACIC SURGERY, 2001, 72 (01) :114-119