Faculty Collaboration Database

Comparing off-pump and on-pump clinical outcomes and costs for diabetic cardiac surgery patients. Ann Thorac Surg 2014 Jul;98(1):38-44; discussion 44-5

Date

05/21/2014

Pubmed ID

24841548

DOI

10.1016/j.athoracsur.2014.03.042

Scopus ID

2-s2.0-84903828936 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

BACKGROUND: Observational studies have documented an off-pump over on-pump advantage for high-risk patients, including diabetic patients. Randomized trials have not confirmed this advantage. The VA Randomization On Versus Off Bypass (ROOBY) trial randomly assigned 2,203 coronary artery bypass graft surgery (CABG) patients at 18 sites to either on-pump (n=1,099) or off-pump (n=1,104) procedures. An a priori ROOBY aim was to evaluate treatment impact on diabetic patients.

METHODS: Actively treated diabetic patients (n=835, receiving oral hypoglycemic or insulin medications) received off-pump CABG (n=402) or on-pump CABG (n=433). The primary ROOBY trial endpoints were a short-term composite (30-day operative death or major complications) and a 1-year composite (death, nonfatal acute myocardial infarction, or repeat revascularization). Secondary ROOBY endpoints included 1-year all-cause death, 1-year graft patency, 1-year changes from baseline in neurocognitive status and health-related quality of life, and costs.

RESULTS: Diabetic patients' risk factors at baseline were balanced across treatments. For diabetic patients, the primary short-term composite outcome rate showed a worse trend for off-pump (8.0%) than on-pump (3.9%, p=0.013), with no difference in the 1-year primary composite outcome or 1-year death rate. One-year patency was 83.1% off-pump versus 88.4% on-pump (p=0.004). No differences were found in neurocognitive, health-related quality of life, discharge cost, and 1-year cumulative cost.

CONCLUSIONS: Concordant with the ROOBY trial's overall findings, off-pump CABG yielded no advantage over on-pump CABG for actively treated diabetic patients. The 1-year graft patency was lower and the short-term composite trended higher for off-pump CABG, with no other significant outcome or cost differences.

Author List

Shroyer AL, Hattler B, Wagner TH, Baltz JH, Collins JF, Carr BM, Almassi GH, Quin JA, Hawkins RB, Kozora E, Bishawi M, Ebrahimi R, Grover FL, VA #517 Randomized On/Off Bypass (ROOBY) Study Group

Author

G Hossein Almassi MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Coronary Circulation
Coronary Vessels
Diabetes Mellitus
Female
Follow-Up Studies
Humans
Hypoglycemic Agents
Incidence
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
United States
Vascular Patency