Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes – a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits
Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the “gold standard” for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, usin...
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| description | Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the “gold standard” for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. A meta-analysis of published randomized clinical trials was used to compare the outcomes. These outcomes included the number of grafts, hospital length of stay, and transfusion rate. They were then incorporated into a decision-analysis model to compare OPCAB with the on-pump surgery, using both conventional high-prime (HP) and low-prime circuits with retrograde autologous prime (LP/RAP). The meta-analysis of randomized clinical trials revealed that OPCAB surgery had 0.33 less grafts (p |
| doi_str_mv | 10.1177/0267659109104146 |
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However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. A meta-analysis of published randomized clinical trials was used to compare the outcomes. These outcomes included the number of grafts, hospital length of stay, and transfusion rate. They were then incorporated into a decision-analysis model to compare OPCAB with the on-pump surgery, using both conventional high-prime (HP) and low-prime circuits with retrograde autologous prime (LP/RAP). The meta-analysis of randomized clinical trials revealed that OPCAB surgery had 0.33 less grafts (p < .05), a reduction of 0.97 days in hospital length of stay (LOS) (p < .05), and a 63.2% reduction in percentage of patients transfused (p < .05). Based on the decision-analysis model, a relatively low major event rate (defined as myocardial infarction, need for angioplasty or surgery) at 4 years of 2% can eliminate the savings associated with OPCAB when compared to a low-prime circuit with RAP. Using a 5% major event rate at 4 years, the predicted cost savings of LP/RAP over OPCAB is $510 per patient or $51,036,746 per 100,000 patients. The development and implementation of low-prime circuits with retrograde autologous prime is an import step in matching the outcomes associated with OPCAB surgery.</description><identifier>ISSN: 0267-6591</identifier><identifier>EISSN: 1477-111X</identifier><identifier>DOI: 10.1177/0267659109104146</identifier><identifier>PMID: 19346262</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Angioplasty ; Autografts ; Bypasses ; Circuits ; Clinical trials ; Coronary artery ; Coronary Artery Bypass - methods ; Coronary Artery Bypass, Off-Pump - methods ; Coronary vessels ; Decision analysis ; Decision Support Techniques ; Grafts ; Heart ; Heart surgery ; Humans ; Mathematical models ; Medical research ; Meta-analysis ; Models, Statistical ; Myocardial infarction ; Patients ; Randomization ; Randomized Controlled Trials as Topic ; Risk Factors ; Surgery ; Surgical outcomes ; Transfusion ; Treatment Outcome ; Veins & arteries</subject><ispartof>Perfusion, 2008-09, Vol.23 (5), p.255-260</ispartof><rights>Copyright Sage Publications Ltd. Sep 2008</rights><rights>SAGE Publications © Sep 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-16318c9ad16f260fbff8066be417f2f9429d348cccaa5390ac18c6abea42fcea3</citedby><cites>FETCH-LOGICAL-c390t-16318c9ad16f260fbff8066be417f2f9429d348cccaa5390ac18c6abea42fcea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0267659109104146$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0267659109104146$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21800,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19346262$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sistino, JJ</creatorcontrib><title>Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes – a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits</title><title>Perfusion</title><addtitle>Perfusion</addtitle><description>Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the “gold standard” for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. A meta-analysis of published randomized clinical trials was used to compare the outcomes. These outcomes included the number of grafts, hospital length of stay, and transfusion rate. They were then incorporated into a decision-analysis model to compare OPCAB with the on-pump surgery, using both conventional high-prime (HP) and low-prime circuits with retrograde autologous prime (LP/RAP). The meta-analysis of randomized clinical trials revealed that OPCAB surgery had 0.33 less grafts (p < .05), a reduction of 0.97 days in hospital length of stay (LOS) (p < .05), and a 63.2% reduction in percentage of patients transfused (p < .05). Based on the decision-analysis model, a relatively low major event rate (defined as myocardial infarction, need for angioplasty or surgery) at 4 years of 2% can eliminate the savings associated with OPCAB when compared to a low-prime circuit with RAP. Using a 5% major event rate at 4 years, the predicted cost savings of LP/RAP over OPCAB is $510 per patient or $51,036,746 per 100,000 patients. The development and implementation of low-prime circuits with retrograde autologous prime is an import step in matching the outcomes associated with OPCAB surgery.</description><subject>Angioplasty</subject><subject>Autografts</subject><subject>Bypasses</subject><subject>Circuits</subject><subject>Clinical trials</subject><subject>Coronary artery</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Artery Bypass, Off-Pump - methods</subject><subject>Coronary vessels</subject><subject>Decision analysis</subject><subject>Decision Support Techniques</subject><subject>Grafts</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Mathematical models</subject><subject>Medical research</subject><subject>Meta-analysis</subject><subject>Models, Statistical</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Transfusion</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>0267-6591</issn><issn>1477-111X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kcFqFTEUhoNY7G1170qCBXdTk0xuZrKUolYouLHgbjiTSS4pk8mYM1lcV76DL-Pz9EnMeC9UCoXAgZzv_384PyGvObvkvGneM6EatdWclSe5VM_IhsumqTjn35-Tzbqu1v0pOUO8Y4xJKesX5JTrWiqhxIb8uUU_7ehgjUcfpwomGPfokcI00GAXePhZIp2THbxZqIkpTpD2FNJiy-j3MyBSzGnnDYw05sXEYJHe__pNgYY42JG6mIowzJDWxOhcNecw_xOtHsU--MnDkpP_aQdqIA0-znkMh6hjhvHJZL_gS3LiYET76jjPye2nj9-urqubr5-_XH24qUyt2VJxVfPWaBi4ckIx1zvXMqV6K3njhNNS6KGWrTEGYFsUYAquoLcghTMW6nPy7uA7p_gjW1y64NHYcYTJxoydUg1nXKsCvn0E3sWcyvGw41pvVS0aWaCLpyHR1oJL3RaKHSiTImKyrpuTD-UIHWfdWnz3uPgieXM0zn2ww4Pg2HQBqgOAsLP_pT5l-BccD7tm</recordid><startdate>20080901</startdate><enddate>20080901</enddate><creator>Sistino, JJ</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20080901</creationdate><title>Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes – a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits</title><author>Sistino, JJ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-16318c9ad16f260fbff8066be417f2f9429d348cccaa5390ac18c6abea42fcea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Angioplasty</topic><topic>Autografts</topic><topic>Bypasses</topic><topic>Circuits</topic><topic>Clinical trials</topic><topic>Coronary artery</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary Artery Bypass, Off-Pump - methods</topic><topic>Coronary vessels</topic><topic>Decision analysis</topic><topic>Decision Support Techniques</topic><topic>Grafts</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Mathematical models</topic><topic>Medical research</topic><topic>Meta-analysis</topic><topic>Models, Statistical</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Transfusion</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sistino, JJ</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Perfusion</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sistino, JJ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes – a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits</atitle><jtitle>Perfusion</jtitle><addtitle>Perfusion</addtitle><date>2008-09-01</date><risdate>2008</risdate><volume>23</volume><issue>5</issue><spage>255</spage><epage>260</epage><pages>255-260</pages><issn>0267-6591</issn><eissn>1477-111X</eissn><abstract>Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the “gold standard” for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. A meta-analysis of published randomized clinical trials was used to compare the outcomes. These outcomes included the number of grafts, hospital length of stay, and transfusion rate. They were then incorporated into a decision-analysis model to compare OPCAB with the on-pump surgery, using both conventional high-prime (HP) and low-prime circuits with retrograde autologous prime (LP/RAP). The meta-analysis of randomized clinical trials revealed that OPCAB surgery had 0.33 less grafts (p < .05), a reduction of 0.97 days in hospital length of stay (LOS) (p < .05), and a 63.2% reduction in percentage of patients transfused (p < .05). Based on the decision-analysis model, a relatively low major event rate (defined as myocardial infarction, need for angioplasty or surgery) at 4 years of 2% can eliminate the savings associated with OPCAB when compared to a low-prime circuit with RAP. Using a 5% major event rate at 4 years, the predicted cost savings of LP/RAP over OPCAB is $510 per patient or $51,036,746 per 100,000 patients. The development and implementation of low-prime circuits with retrograde autologous prime is an import step in matching the outcomes associated with OPCAB surgery.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>19346262</pmid><doi>10.1177/0267659109104146</doi><tpages>6</tpages></addata></record> |
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| ispartof | Perfusion, 2008-09, Vol.23 (5), p.255-260 |
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| language | eng |
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| source | SAGE Complete A-Z List; MEDLINE |
| subjects | Angioplasty Autografts Bypasses Circuits Clinical trials Coronary artery Coronary Artery Bypass - methods Coronary Artery Bypass, Off-Pump - methods Coronary vessels Decision analysis Decision Support Techniques Grafts Heart Heart surgery Humans Mathematical models Medical research Meta-analysis Models, Statistical Myocardial infarction Patients Randomization Randomized Controlled Trials as Topic Risk Factors Surgery Surgical outcomes Transfusion Treatment Outcome Veins & arteries |
| title | Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes – a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits |
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