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OBJECTIVE: To evaluate the effect of age on comparative early outcomes of off-pump (OPCAB) versus on-pump coronary artery bypass grafting (CABG).
METHODS: The Nationwide Inpatient Sample registry was utilized to identify patients undergoing isolated OPCAB or on-pump CABG between 2003-2008. Patients were stratified into 4 cohorts according to age: 50-59.9 years, 60-69.9 years, 70-79.9 years, and 80 years of age or older. Outcomes were compared within each age group between OPCAB and on-pump CABG. These outcomes included operative mortality, defined as occurring during the same admission as CABG, postoperative stroke, postoperative major cardiac complication, and hospital cost.
RESULTS: A total of 107,777 OPCAB and 1,165,996 on-pump CABG patients were identified. OPCAB and on-pump CABG patients had similar comorbidities and operative acuity within each age cohort (each p>0.05). Within each age cohort, females were more prevalent in OPCAB compared to on-pump CABG by 2-3% (each p<0.001). For patients under the age of 80 years, the operative mortality was significantly higher in OPCAB (Figure). For those 80 years or older, operative mortality was comparable between OPCAB and on-pump CABG (p=0.57). Postoperative cardiac complication rates were similar between approaches for each age group (each p>0.05). For patients younger than 70 years, postoperative stroke rates were comparable (Figure). OPCAB was associated with reduced postoperative stroke in patients 70-79.9 years (p<0.001) and patients 80 years or older (p=0.02). Although hospital costs were higher with OPCAB compared to on-pump CABG in patients younger than 80 years, costs were comparable in those 80 years or older (OPCAB $45,009 versus on-pump $43,617, p=0.18).
CONCLUSIONS: In this analysis of over 1.2 million CABG patients in the United States, patient age modified the comparative outcomes of OPCAB versus on-pump CABG. Moreover, with increasing age, operative mortality rates and hospital costs equalized between surgical approaches, and postoperative stroke rates became significantly lower with OPCAB compared to on-pump CABG. These data collectively suggest that elderly patients may derive greater short-term benefit with OPCAB than younger patients.