Economic outcome of off-pump coronary artery bypass surgery: A prospectiverandomized study

Background. Emphasis on cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. The reviv al of interest in off-pump (beating heart) coronary artery bypass surgery m ay influence the economic outcome. This study examines these effects. Methods. Two hundred patients undergoing first-time coronary artery bypass surgery were prospectively randomized to either conventional cardiopulmonar y bypass and cardioplegic arrest or off-pump surgery. Variable and fixed di rect costs were obtained for each group during operative and postoperative care. The data were analyzed using parametric methods. Results. There was no difference between the groups with respect to pre- an d intraoperative patient variables. Off-pump surgery was significantly less costly than conventional on-pump surgery with respect to operating materia ls, bed occupancy, and transfusion requirements (total mean cost per patien t: on pump, $3,731.6 +/- 1,169.7 vs off-pump, $2,615.13 +/- 953.6; p < 0.00 1). Morbidity was significantly higher in the on-pump group, which was refl ected in an increased cost. Conclusions. Off-pump revascularization offers a safe, cost-effective alter native to conventional coronary revascularization with cardiopulmonary bypa ss and cardioplegic arrest. (C) 1999 by The Society of Thoracic Surgeons.