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Right arrow Minimally invasive surgery

Ann Thorac Surg 2005;79:1584-1589
© 2005 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Patient-Reported Outcome After Randomization to On-Pump Versus Off-Pump Coronary Artery Surgery

Lars Mathisen, RN, MSNa,*, Marit H. Andersen, RN, MSNb, Per K. Hol, MDc, Per S. Lingaas, MDa, Runar Lundblad, MD, PhDa, Kjell A. Rein, MD, PhDa, Tor I. Tønnessen, MD, PhDc, Bjørn E. Mørk, MSc, Jan-Ludvig Svennevig, MD, PhDa, Astrid K. Wahl, RN, PhDd, Berit R. Hanestad, RN, PhDe, Erik Fosse, MD, PhDc

a Department of Thoracic and Cardiovascular Surgery, Rikshospitalet University Hospital, Oslo, Norway
b Department of Surgery, Rikshospitalet University Hospital, Oslo, Norway
c The Interventional Center, Rikshospitalet University Hospital, Oslo, Norway
d Oslo University College of Nursing, Oslo, Norway
e Institute of Public Health, Faculty of Social Sciences, University of Bergen, Bergen, Norway

Accepted for publication October 14, 2004.

* Address reprint requests to Mr Mathisen, Department of Thoracic and Cardiovascular Surgery, Rikshospitalet University Hospital, Oslo N-0027, Norway; (E-mail: lars.mathisen{at}rikshospitalet.no).

BACKGROUND: Clinical experience with off-pump coronary artery bypass surgery raises the question of a patient experienced benefit compared with on-pump surgery. This prospective and randomized study compared patient-reported outcome between surgical groups, as change scores at 3 months after surgery and longitudinally as time-averaged change from baseline through the first year after surgery.

METHODS: In all, 120 patients were randomly assigned to on- or off-pump coronary artery surgery. A questionnaire for patient self-report of angina (Canadian Cardiovascular Society scale), health status (Short Form 36, sleep and sexual difficulty), and overall quality of life (Quality of Life Scale) was administered at baseline and at 3, 6, and 12 months after surgery.

RESULTS: Patient groups were comparable with regard to age, symptoms, comorbidity, and surgical characteristics. Both groups experienced a median of two classes relief of angina at 3 months (p < 0.0005), maintained throughout follow-up. Paired t tests revealed significant improvement on all Short Form 36 subscales at 3 months after surgery, with the exception of physical role functioning in the on-pump group. No independent main effects of surgical group were observed in the between-groups covariance models. The longitudinal effect of sex was significant in four Short Form 36 subscales: physical functioning, bodily pain, and role limitation due to physical or emotional problems. Overall quality of life scores were stable in both groups.

CONCLUSIONS: Both on-pump and off-pump patients reported less angina and improved health status after surgery. There were no significant differences between surgical groups in health status or overall quality of life, neither cross-sectionally nor longitudinally.




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