Comparison of postoperative pain and quality of life between left anterior thoracotomy and median sternotomy off-pump coronary artery bypass surgery in multivessel coronary revascularization: a retrospective study of a case series of 356 consecutive patients

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Background This study compared post-operative pain and quality of life (QoL) between left anterior thoracotomy (LAT) and median sternotomy (MS) in off-pump coronary artery bypass grafting (OPCAB). LAT is a less invasive alternative to MS for the treatment of advanced coronary artery disease. Methods This retrospective study analysed 356 patients who underwent OPCAB for multivessel revascularization between January 2018 and April 2023. Patients were divided into LAT (n = 169) and MS (n = 187) groups. Postoperative pain was measured using a Visual Analog Scale (VAS). QoL was assessed using the Short Form-36 (SF-36) questionnaire preoperatively and postoperatively. Results Patients with LAT had significantly lower pain scores on postoperative days 1, 3, and 7 (p < 0.001) than those with MS. LAT was associated with shorter ICU and hospital stay (p = 0.011 and p < 0.001, respectively). The QoL scores for physical domains were higher in the LAT group at 1 and 3 months post-surgery (p < 0.01). No significant differences were observed in the mental health domains between groups. Conclusions LAT for multivessel OPCAB is associated with reduced postoperative pain, shorter hospital stay, and improved early QoL, particularly in physical domains, compared to MS. These findings suggest that LAT is a preferable option for suitable patients, promoting faster recovery and better early postoperative outcomes.