Prophylactic value of preincision intra-aortic balloon pump: analysis of a statewide experience
Department of Quantitative Health Sciences
Medical Subject Headings
Aged; Alabama; Analysis of Variance; Comorbidity; *Coronary Artery Bypass; Coronary Disease; Female; Follow-Up Studies; Hemodynamics; Humans; *Intra-Aortic Balloon Pumping; data; Intraoperative Care; Length of Stay; Logistic Models; Male; *Patient Selection; Postoperative Complications; Proportional Hazards Models; Risk Factors; Survival Analysis; Time Factors; Treatment Outcome
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
OBJECTIVE: The objective of this study was to determine whether preincision use of an intra-aortic balloon pump improves survival and shortens postoperative length of stay in hemodynamically stable, high-risk patients undergoing coronary artery bypass grafting.
METHODS: A post hoc analysis of the Alabama CABG Cooperative Project database was performed by using propensity scores to model the likelihood of receiving a prophylactic preincision intra-aortic balloon pump. Every patient receiving a prophylactic preincision balloon pump was matched with another patient of similar propensity score who did not receive one. We then compared outcomes for matched pairs.
RESULTS: There were 7581 patients of whom 592 received a prophylactic preincision balloon pump. Patients with preoperative renal insufficiency, heart failure, or left main coronary artery disease, or who had undergone previous bypass grafting were significantly more likely to receive a prophylactic preincision balloon pump. By using propensity scores, we matched 550 patients who received a prophylactic preincision balloon pump with 550 who did not. Survival did not significantly differ by whether a prophylactic preincision balloon pump was used. However, surviving patients who received a preincision balloon pump had a significantly shorter postbypass length of stay (7 +/- 7.3 days) than did matched patients not receiving a balloon pump (8 +/- 6.2 days; P <.05).
CONCLUSIONS: No survival advantage was found for use of a prophylactic intra-aortic balloon pump in hemodynamically stable, high-risk patients undergoing bypass grafting, as opposed to placing a balloon pump on an "as needed" basis during or after the operation. However, the patients receiving the balloon pump had improved convalescence as shown by significantly shorter length of stay.
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Citation: J Thorac Cardiovasc Surg. 2000 Dec;120(6):1112-9.
Holman, William L.; Li, Qing; Kiefe, Catarina I.; McGiffin, David C.; Peterson, Eric D.; Allman, Richard M.; Nielsen, Vance G.; and Pacifico, Albert D., "Prophylactic value of preincision intra-aortic balloon pump: analysis of a statewide experience" (2000). Quantitative Health Sciences Publications and Presentations. 121.