Effect of off-pump coronary artery bypass grafting on risk-adjusted and cumulative sum failure outcomes after coronary artery surgery

Richard J. Novick, Stephanie A. Fox, Larry W. Stitt, Bob B. Kiaii, Walid Abu-Khudair, Alex Lee, Anas Benmusa, Stuart A. Swinamer, Reiza Rayman, Alan H. Menkis, F. Neil McKenzie, Mackenzie A. Quantz, Walter D Boyd

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and Aim: We have shown that cumulative sum (CUSUM) failure analysis may be more sensitive than standard statistical methods in detecting a cluster of adverse patient outcomes after cardiac surgical procedures. We therefore applied CUSUM, as well as standard statistical techniques, to analyze a surgeon's experience with off-pump coronary artery bypass grafting (OPCAB) and on-pump procedures to determine whether the two techniques have similar or different outcomes. Methods: In 320 patients undergoing nonemergent, first time coronary artery bypass grafting, preoperative patient characteristics, rates of mortality and major complications, and ICU and hospital lengths of stay were compared between the on-pump and OPCAB cohorts using Fisher's exact tests and Wilcoxon two sample tests. Predicted mortality and length of stay were determined using previously validated models of the Cardiac Care Network of Ontario. Observed versus expected ratios of both variables were calculated for the two types of procedures. Furthermore, CUSUM curves were constructed for the on-pump and OPCAB cohorts. A multivariable analysis of the predictors of hospital length of stay was also performed to determine whether the type of coronary artery bypass procedure had an independent impact on this variable. Results: The predicted mortality risk and predicted hospital length of stay were almost identical in the 208 on-pump patients (2.2 ± 3.9%; 8.2 ± 2.5 days) and the 112 OPCAB patients (2.0 ± 2.2%; 7.8 ± 2.1 days), the incidence of hospital mortality and postoperative stroke were 2.9% and 2.4% in on-pump patients versus zero in OPCAB patients (p = 0.09 and 0.17, respectively). Mechanical ventilation for greater than 48 hours was significantly less common in OPCAB (1.8%) than in on-pump patients (7.7%, p = 0.04). The rate of 10 major complications was 14.9% in on-pump versus 8.0% in OPCAB patients (p = 0.08). OPCAB patients experienced a hospital length of stay that was a median of 1.0 day shorter than on-pump patients (p = 0.01). The observed versus expected ratio for length of stay was 0.78 in OPCAB patients versus 0.95 in on-pump patients. On CUSUM analysis, the failure curve in OPCAB patients was negative and was flatter than that of on-pump patients throughout the duration of the study. Furthermore, OPCAB was an independent predictor of a reduced hospital length of stay on multivariable analysis. Conclusions: OPCAB was associated with better outcomes than on-pump coronary artery bypass despite a similar predicted risk. This robust finding was documented on sensitive CUSUM analysis, using standard statistical techniques and on a multivariable analysis of the independent predictors of hospital length of stay.

Original languageEnglish (US)
Pages (from-to)520-528
Number of pages9
JournalJournal of Cardiac Surgery
Volume17
Issue number6
DOIs
StatePublished - Nov 2002
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Coronary Vessels
Length of Stay
Mortality
Cardiac Surgical Procedures
Ontario
Hospital Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of off-pump coronary artery bypass grafting on risk-adjusted and cumulative sum failure outcomes after coronary artery surgery. / Novick, Richard J.; Fox, Stephanie A.; Stitt, Larry W.; Kiaii, Bob B.; Abu-Khudair, Walid; Lee, Alex; Benmusa, Anas; Swinamer, Stuart A.; Rayman, Reiza; Menkis, Alan H.; McKenzie, F. Neil; Quantz, Mackenzie A.; Boyd, Walter D.

In: Journal of Cardiac Surgery, Vol. 17, No. 6, 11.2002, p. 520-528.

Research output: Contribution to journalArticle

Novick, RJ, Fox, SA, Stitt, LW, Kiaii, BB, Abu-Khudair, W, Lee, A, Benmusa, A, Swinamer, SA, Rayman, R, Menkis, AH, McKenzie, FN, Quantz, MA & Boyd, WD 2002, 'Effect of off-pump coronary artery bypass grafting on risk-adjusted and cumulative sum failure outcomes after coronary artery surgery', Journal of Cardiac Surgery, vol. 17, no. 6, pp. 520-528. https://doi.org/10.1046/j.1540-8191.2002.01008.x
Novick, Richard J. ; Fox, Stephanie A. ; Stitt, Larry W. ; Kiaii, Bob B. ; Abu-Khudair, Walid ; Lee, Alex ; Benmusa, Anas ; Swinamer, Stuart A. ; Rayman, Reiza ; Menkis, Alan H. ; McKenzie, F. Neil ; Quantz, Mackenzie A. ; Boyd, Walter D. / Effect of off-pump coronary artery bypass grafting on risk-adjusted and cumulative sum failure outcomes after coronary artery surgery. In: Journal of Cardiac Surgery. 2002 ; Vol. 17, No. 6. pp. 520-528.
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abstract = "Background and Aim: We have shown that cumulative sum (CUSUM) failure analysis may be more sensitive than standard statistical methods in detecting a cluster of adverse patient outcomes after cardiac surgical procedures. We therefore applied CUSUM, as well as standard statistical techniques, to analyze a surgeon's experience with off-pump coronary artery bypass grafting (OPCAB) and on-pump procedures to determine whether the two techniques have similar or different outcomes. Methods: In 320 patients undergoing nonemergent, first time coronary artery bypass grafting, preoperative patient characteristics, rates of mortality and major complications, and ICU and hospital lengths of stay were compared between the on-pump and OPCAB cohorts using Fisher's exact tests and Wilcoxon two sample tests. Predicted mortality and length of stay were determined using previously validated models of the Cardiac Care Network of Ontario. Observed versus expected ratios of both variables were calculated for the two types of procedures. Furthermore, CUSUM curves were constructed for the on-pump and OPCAB cohorts. A multivariable analysis of the predictors of hospital length of stay was also performed to determine whether the type of coronary artery bypass procedure had an independent impact on this variable. Results: The predicted mortality risk and predicted hospital length of stay were almost identical in the 208 on-pump patients (2.2 ± 3.9{\%}; 8.2 ± 2.5 days) and the 112 OPCAB patients (2.0 ± 2.2{\%}; 7.8 ± 2.1 days), the incidence of hospital mortality and postoperative stroke were 2.9{\%} and 2.4{\%} in on-pump patients versus zero in OPCAB patients (p = 0.09 and 0.17, respectively). Mechanical ventilation for greater than 48 hours was significantly less common in OPCAB (1.8{\%}) than in on-pump patients (7.7{\%}, p = 0.04). The rate of 10 major complications was 14.9{\%} in on-pump versus 8.0{\%} in OPCAB patients (p = 0.08). OPCAB patients experienced a hospital length of stay that was a median of 1.0 day shorter than on-pump patients (p = 0.01). The observed versus expected ratio for length of stay was 0.78 in OPCAB patients versus 0.95 in on-pump patients. On CUSUM analysis, the failure curve in OPCAB patients was negative and was flatter than that of on-pump patients throughout the duration of the study. Furthermore, OPCAB was an independent predictor of a reduced hospital length of stay on multivariable analysis. Conclusions: OPCAB was associated with better outcomes than on-pump coronary artery bypass despite a similar predicted risk. This robust finding was documented on sensitive CUSUM analysis, using standard statistical techniques and on a multivariable analysis of the independent predictors of hospital length of stay.",
author = "Novick, {Richard J.} and Fox, {Stephanie A.} and Stitt, {Larry W.} and Kiaii, {Bob B.} and Walid Abu-Khudair and Alex Lee and Anas Benmusa and Swinamer, {Stuart A.} and Reiza Rayman and Menkis, {Alan H.} and McKenzie, {F. Neil} and Quantz, {Mackenzie A.} and Boyd, {Walter D}",
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T1 - Effect of off-pump coronary artery bypass grafting on risk-adjusted and cumulative sum failure outcomes after coronary artery surgery

AU - Novick, Richard J.

AU - Fox, Stephanie A.

AU - Stitt, Larry W.

AU - Kiaii, Bob B.

AU - Abu-Khudair, Walid

AU - Lee, Alex

AU - Benmusa, Anas

AU - Swinamer, Stuart A.

AU - Rayman, Reiza

AU - Menkis, Alan H.

AU - McKenzie, F. Neil

AU - Quantz, Mackenzie A.

AU - Boyd, Walter D

PY - 2002/11

Y1 - 2002/11

N2 - Background and Aim: We have shown that cumulative sum (CUSUM) failure analysis may be more sensitive than standard statistical methods in detecting a cluster of adverse patient outcomes after cardiac surgical procedures. We therefore applied CUSUM, as well as standard statistical techniques, to analyze a surgeon's experience with off-pump coronary artery bypass grafting (OPCAB) and on-pump procedures to determine whether the two techniques have similar or different outcomes. Methods: In 320 patients undergoing nonemergent, first time coronary artery bypass grafting, preoperative patient characteristics, rates of mortality and major complications, and ICU and hospital lengths of stay were compared between the on-pump and OPCAB cohorts using Fisher's exact tests and Wilcoxon two sample tests. Predicted mortality and length of stay were determined using previously validated models of the Cardiac Care Network of Ontario. Observed versus expected ratios of both variables were calculated for the two types of procedures. Furthermore, CUSUM curves were constructed for the on-pump and OPCAB cohorts. A multivariable analysis of the predictors of hospital length of stay was also performed to determine whether the type of coronary artery bypass procedure had an independent impact on this variable. Results: The predicted mortality risk and predicted hospital length of stay were almost identical in the 208 on-pump patients (2.2 ± 3.9%; 8.2 ± 2.5 days) and the 112 OPCAB patients (2.0 ± 2.2%; 7.8 ± 2.1 days), the incidence of hospital mortality and postoperative stroke were 2.9% and 2.4% in on-pump patients versus zero in OPCAB patients (p = 0.09 and 0.17, respectively). Mechanical ventilation for greater than 48 hours was significantly less common in OPCAB (1.8%) than in on-pump patients (7.7%, p = 0.04). The rate of 10 major complications was 14.9% in on-pump versus 8.0% in OPCAB patients (p = 0.08). OPCAB patients experienced a hospital length of stay that was a median of 1.0 day shorter than on-pump patients (p = 0.01). The observed versus expected ratio for length of stay was 0.78 in OPCAB patients versus 0.95 in on-pump patients. On CUSUM analysis, the failure curve in OPCAB patients was negative and was flatter than that of on-pump patients throughout the duration of the study. Furthermore, OPCAB was an independent predictor of a reduced hospital length of stay on multivariable analysis. Conclusions: OPCAB was associated with better outcomes than on-pump coronary artery bypass despite a similar predicted risk. This robust finding was documented on sensitive CUSUM analysis, using standard statistical techniques and on a multivariable analysis of the independent predictors of hospital length of stay.

AB - Background and Aim: We have shown that cumulative sum (CUSUM) failure analysis may be more sensitive than standard statistical methods in detecting a cluster of adverse patient outcomes after cardiac surgical procedures. We therefore applied CUSUM, as well as standard statistical techniques, to analyze a surgeon's experience with off-pump coronary artery bypass grafting (OPCAB) and on-pump procedures to determine whether the two techniques have similar or different outcomes. Methods: In 320 patients undergoing nonemergent, first time coronary artery bypass grafting, preoperative patient characteristics, rates of mortality and major complications, and ICU and hospital lengths of stay were compared between the on-pump and OPCAB cohorts using Fisher's exact tests and Wilcoxon two sample tests. Predicted mortality and length of stay were determined using previously validated models of the Cardiac Care Network of Ontario. Observed versus expected ratios of both variables were calculated for the two types of procedures. Furthermore, CUSUM curves were constructed for the on-pump and OPCAB cohorts. A multivariable analysis of the predictors of hospital length of stay was also performed to determine whether the type of coronary artery bypass procedure had an independent impact on this variable. Results: The predicted mortality risk and predicted hospital length of stay were almost identical in the 208 on-pump patients (2.2 ± 3.9%; 8.2 ± 2.5 days) and the 112 OPCAB patients (2.0 ± 2.2%; 7.8 ± 2.1 days), the incidence of hospital mortality and postoperative stroke were 2.9% and 2.4% in on-pump patients versus zero in OPCAB patients (p = 0.09 and 0.17, respectively). Mechanical ventilation for greater than 48 hours was significantly less common in OPCAB (1.8%) than in on-pump patients (7.7%, p = 0.04). The rate of 10 major complications was 14.9% in on-pump versus 8.0% in OPCAB patients (p = 0.08). OPCAB patients experienced a hospital length of stay that was a median of 1.0 day shorter than on-pump patients (p = 0.01). The observed versus expected ratio for length of stay was 0.78 in OPCAB patients versus 0.95 in on-pump patients. On CUSUM analysis, the failure curve in OPCAB patients was negative and was flatter than that of on-pump patients throughout the duration of the study. Furthermore, OPCAB was an independent predictor of a reduced hospital length of stay on multivariable analysis. Conclusions: OPCAB was associated with better outcomes than on-pump coronary artery bypass despite a similar predicted risk. This robust finding was documented on sensitive CUSUM analysis, using standard statistical techniques and on a multivariable analysis of the independent predictors of hospital length of stay.

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