Ra. Lancey et al., Off-pump versus on-pump coronary artery bypass surgery: A case-matched comparison of clinical outcomes and costs, HEART SUR F, 3(4), 2000, pp. 277-281
BACKGROUND: Results of off-pump coronary artery bypass (OPCAB) surgery have
demonstrated trends toward fewer complications, faster recoveries and lowe
r costs compared with on-pump coronary artery bypass (ONCAB) surgery. The v
alidity of such comparisons, however, may be impacted by differences in pre
operative risk factors between the two surgeries.
METHODS: A total of 76 OPCAB surgery patients were case-matched (by age, se
x and Society of Thoracic Surgeons' risk scores) with an equal number of pa
tients who underwent ONCAB surgery by the same surgeon. Postoperative clini
cal parameters (time on mechanical ventilation, number of blood transfusion
s, peak cardiac enzyme levels and metabolic acidosis) and outcomes data (in
tensive care unit and overall in-hospital lengths of stay, perioperative my
ocardial infarction, atrial fibrillation, stroke, reoperation for bleeding
and mortality) were analyzed, and the variable and total costs for each pat
ient were calculated.
RESULTS: OPCAB patients required less mechanical ventilation and fewer bloo
d transfusions and had lower peak creatinine phosphokinase levels, as well
as a reduced incidence of metabolic acidosis. There were trends toward both
shorter intensive care unit and overall in-hospital lengths of stay for OP
CAB patients. The average total cost for this group was 20.5% less than for
ONCAB patients. There were no differences in rates of atrial fibrillation,
myocardial infarction, reoperation for bleeding, stroke or mortality.
CONCLUSIONS: By reducing the need for mechanical ventilation, transfusions
and intensive care unit and overall in-hospital lengths of stay, OPCAB surg
ery decreases the use of limited and costly resources without increasing ri
sks. These advantages do not appear to be related to patient selection.