Resource Utilization in Off-Pump versus Conventional Coronary Artery Bypass Grafting in a Community Hospital: A Comparative Analysis Using Propensity Scoring
DOI:
https://doi.org/10.1532/HSF98.201011115Abstract
Background: At a time when cost containment in health care is under increased scrutiny, coronary artery bypass grafting remains the most widely performed cardiac surgical procedure in the world. This study compares 30-day mortality, morbidity, and resource use for off-pump coronary artery bypass (OPCAB) versus conventional coronary artery bypass (CCAB) revascularization.
Methods: From January 2000 through December 2008, 1003 patients underwent OPCAB grafting by a single surgeon (S.C.S.). Data were prospectively collected, entered into a Society of Thoracic Surgeons adult cardiac surgery database, and analyzed retrospectively. We used propensity-matching techniques to match this cohort to a group of 1003 patients who underwent CCAB.
Results: The hospital mortality rate was lower for the OPCAB patients than for the CCAB patients: 2.0% (20/1003) versus 2.8% (28/1003). Predictors of hospital mortality for the entire cohort included age (P = .001), cardiogenic shock (P = .001), congestive heart failure (P = .019), history of myocardial infarction (P = .001), and reoperation (P = .007). The overall incidence of morbidity was lower for the OPCAB patients (reoperation for bleeding, P = .011; prolonged ventilation, P = .035; stroke, P = .045; cardiac arrest, P = .004). OPCAB patients experienced significantly reduced procedure times (P = .001), postoperative ventilation times (P = .035), post-operative lengths of stay (P = .035), and blood product use (intraoperative, P = .001; postoperative, P = .001).
Conclusion: These outcomes clearly demonstrate that OPCAB is a safe and effective procedure for myocardial revascularization. This retrospective, nonrandomized observational study has shown that the patients who underwent OPCAB had reduced morbidity and mortality, as well as decreased resource use, compared with those who underwent CCAB.
References
Arom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.nAscione R, Lloyd CT, Underwood MJ, Attilio AL, Pitsis AA, Angelini GD. 1999. Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study. Ann Thorac Surg 68:2237-42.nAscione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. 1999. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 68:493-8.nAscione R, Williams S, Lloyd C, Sundaramoorthi T, Pitsis AA, Agelini GD. 2001. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.nBergsland J, Karamanoukian HL, Soltoski PR, Salerno TA. 1999. "Single suture" for circumflex exposure in off-pump coronary artery bypass grafting. Ann Thorac Surg 68:1428-30.nBerson AJ, Smith JM, Woods SE, Hasselfield KA, Hiratzka LF. 2004. Off-pump versus on-pump coronary artery bypass surgery: does the pump influence outcome? J Am Coll Surg 199:102-8.nCarlson A, Culliford T, Gold JP, et al. 2007. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation 116:1145-52.nChen Y, Wan F. 2009. Off-pump coronary artery bypass graft surgery: a training course for novices and its learning curve. Thorac Cardiovasc Surg 57:141-7.nCheng DC, Bainbridge D, Martin JE, Novick RJ. 2005. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology 102:188-203.nFavaloro RG. 1969. Saphenous vein graft in the surgical treatment of coronary artery disease. J Thorac Cardiovasc Surg 58:178-85.nKolessov VI. 1967. Mammary artery-coronary artery anastomosis as a method for treating angina pectoris. J Thorac Cardiovasc Surg 54:535-44.nLytle BW, Sabik JF. 2004. On-pump and off-pump bypass surgery: tools for revascularization. Circulation 109:810-2.nParolari, A, Alamanni F, Polvani G, et al. 2005. Meta-analysis of randomized trials comparing off-pump with on-pump coronary artery bypass graft patency. Ann Thorac Surg 80:2121-5.nPatel NC, Deodhar AP, Grayson AD, et al. 2002. Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass. Ann Thorac Surg 74:400-6.nPenttila HJ, Lepojarvi K, Kiviluoma KT, Kaukoranta PK, Hassinen IE, Peuhkurinen KJ. 2001. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass. Ann Thorac Surg 71:565-71.nPuskas JD, Kilgo PD, Lattouf OM, et al. 2008. Off-pump coronary artery bypass provides reduced morbidity and mortality and equivalent 10-year survival. Ann Thorac Surg 86:1139-46.nPuskas JD, Wright CE, Ronson RS, Brown WM, Gott JP, Guyton RA. 1998. Off-pump multivessel coronary artery bypass via sternotomy is safe and effective. Ann Thorac Surg 66:1068-72.nPuskas JD, Wright CE, Ronson RS, Brown WM, Gott JP, Guyton RA. 1999. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surgery Forum 2:216-21.nReston JT, Tregear SJ, Turkelson CM. 2003. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg 76:1510-5.nRosenbaum PR. 1989. Optimal matching for observational studies. J Am Stat Assoc 84:1024-32.nSong HK, Petersen RJ, Sharoni E, Guyton RA, Puskas JD. 2003. Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve. Eur J Cardiothorac Surg 24:947-52.nStamou SC, Jablonski KA, Pfister AJ, et al. 2002. Stroke after conventional versus minimally invasive coronary artery bypass. Ann Thorac Surg 74:394-9.nVallely MP, Bannon PG, Kritharides L. 2001. The systemic inflammatory response syndrome and off-pump cardiac surgery. Heart Surgery Forum 4(suppl 1):S7-13.nWilliams BC, Demitrack LB, Fries BE. 1992. The accuracy of the National Death Index when personal identifiers other than Social Security number are used. Am J Public Health 82:1145-7.n
