Influence of Body Size on Clinical Outcome in Patients Undergoing Coronary Surgery with or Without Cardiopulmonary Bypass
Notice bibliographique
Résumé
Objective: Coronary artery bypass grafting (CABG) in overweight patients carries significant morbidity. We compare the effectiveness of off-pump coronary artery bypass (OPCAB) surgery versus conventional CABG using cardiopulmonary bypass and cardioplegic arrest, in a consecutive series of overweight patients. Methods:From April 1996 to April 2001, data from 4321 patients undergoing coronary revascularisation (mortality 1.4%) were prospectively entered into the Patients Analysis and Tracking System. Data were extracted for all patients with a body mass index (BMI) ≥ 25. In hospital mortality and early morbidity were compared between patients undergoing on- and off-pump coronary surgery. A risk-adjusted analysis was also carried out to assess the influence of surgery on outcomes. Results: 2844 overweight patients with BMI ≥ 25 were identified, and of these 674 (23.7%) were operated on with off-pump surgery. On-pump patients were less likely to have unstable angina, hypercholesterolaemia, to have coronary disease involving the left main stem, or to have a BMI ≥ 30. However, they had more extensive coronary disease, were more likely to have suffered previous myocardial infarction, and received more grafts than those undergoing off-pump surgery. Intra- and post-operative arrhythmias, inotropic use, and post-operative low cardiac output, use of IABP, blood loss, transfusion requirement, chest infections, neurological complications including permanent stroke, ICU and hospital stay all were significantly reduced in the off-pump group (all p < 0.05). After adjustment for age, gender, ejection fraction, extent of coronary disease, and degree of urgency, odd ratios (ORs) for most of the adverse outcomes investigated, confirmed significant benefit of off-pump surgery (table). The point estimate of the adjusted effect size for in-hospital mortality also indicated benefit from off-pump surgery (table). Variable On-Pump (2169) Off-Pump (674) OR/Mean Difference 95% CI p Death 20 (0.92%) 2 (0.29%) 0.37 0.08, 1.59 0.18 Postoperative MI 35 (1.6%) 14 (2.0%) 1.37 0.72, 2.62 0.337 New Inotropes 879 (40.5%) 219 (32.5%) 0.8 0.66, 0.97 0.02 New IABP 54 (2.5%) 5 (0.7%) 0.32 0.12, 0.8 0.015 Ward arrhythmia 320 (14.8%) 65 (9.6%) 0.63 0.47, 0.84 0.002 Chest Infection 106 (4.9%) 14 (2.1%) 0.43 0.24, 0.76 0.004 Neurolog. Complic. 59 (2.7%) 6 (0.9%) 0.36 0.15, 0.85 0.02 Blood Loss (ml) 939.9(512.3) 856.2 (582.1) −60.8 −111.7, −9.87 0.019 Total RBCs (unit) 1.05 (1.51) 0.436 (1.52) −0.51 −0.65, −0.37 0.0001 Total Platelets (unit) 0.24 (0.81) 0.08 (0.455) −0.157 −0.23, −0.08 0.0001 Total FFP (unit) 0.49 (1.48) 0.126 (0.72) −0.38 −0.5, −0.25 0.0001 Sternal rewiring 17 (0.78%) 1 (0.14%) −0.22 0.03, 1.7 0.15 Renal complications 98 (4.5%) 24 (3.56%) −0.74 0.44, 1.25 0.265 Hospital stay (day) 7.76 (4.26) 6.64 (3.04) −0.94 −1.39, −0.49 0.0001 Conclusions: These results suggest that off-pump surgery is safe, effective and associated with reduced morbidity in overweight patients.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».