Coronary Revascularization Surgical Techniques and Outcomes in Octogenarians: A Multicenter Retrospective Matched Study

Introduction: Coronary artery bypass grafting (CABG) is commonly performed for treating coronary artery disease (CAD) in octogenarians. This entails higher risk and resource utilization compared to younger patients. This retrospective multicenter study evaluates CABG outcomes in octogenarians, with a particular focus on the impact of off‐pump (OPCAB) versus on‐pump (ONCAB) CABG techniques. Methods: We conducted a retrospective analysis of isolated OPCAB and ONCAB procedures in octogenarians from January 1, 2015, to June 30, 2023, across 8 centers within a single health system. All cases submitted to the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were included. The primary outcome was 30‐day mortality; secondary outcomes included STS‐defined postoperative complications. We performed a stabilized inverse probability treatment weighted (sIPTW) matching technique to balance baseline covariates between the two groups. Results: Across eight centers, 470 (7%) CABG procedures were performed in octogenarians, with 207 (44%) underwent OPCAB and 263 (56%) ONCAB. Prior to matching, overall 30‐day all‐cause mortality rate was 6.6% in octogenarians. After sIPTW matching, 30‐day mortality (primary outcome) rates were comparable between OPCAB and ONCAB (2.4% vs. 4.4%; p = 0.71). However, OPCAB was associated with lower rates of composite complications (28% relative risk reduction (RRR), p = 0.003), including pneumonia (89% RRR, p = 0.023), atrial fibrillation (30% RRR, p = 0.013), and discharge‐to‐acute care facilities (ACFs) (36% RRR, p = 0.003). Resource utilization was also lower in the OPCAB group, with shorter median hospital stays (6 [3–7] vs. 7 [6–9] days, p = 0.002) and reduced ventilator time (4.3 [0.8–9] vs. 8.4 [4.7–21] hours, p = 0.009). Conclusion: In octogenarians, OPCAB and ONCAB found comparable 30‐day mortality. However, OPCAB was associated with fewer complications, shorter hospital stays, reduced ventilator hours, lower blood transfusion requirements, and higher discharge‐to‐home rates, suggesting potential advantages in resource utilization and patient recovery.