Journal article
Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
The Journal of thoracic and cardiovascular surgery, Vol.137(5), pp.1116-1123.e1
05/2009
DOI: 10.1016/j.jtcvs.2008.12.038
PMID: 19379976
Abstract
Coronary artery bypass grafting performed off-pump has emerged in recent years as a less morbid alternative to on-pump bypass grafting. However, the impact of hospital volume on the outcomes of off-pump relative to on-pump bypass grafting has not been evaluated.
We conducted a retrospective study of patients undergoing off-pump (n = 26,011) and on-pump (n = 99,344) coronary artery bypass grafting during 2000 through 2004 in 124 California hospitals, using the California Patient Discharge Database. Generalized linear mixed models were used to compare in-hospital mortality and postoperative complications in patients undergoing on-pump versus off-pump bypass grafting, accounting sequentially for differences in patient characteristics and hospital-level effects. The relative mortality and complication rates for patients undergoing on-pump versus off-pump coronary bypass were evaluated across hospital volume quartiles.
Mean length of stay was lower for patients who underwent off-pump compared with on-pump bypass grafting (8.7 vs 9.6 days; P < .001), as were unadjusted mortality and complication rates (2.2% vs 3.3%; 10.1% vs 11.6%, respectively; P < .001). For hospitals in the highest percent off-pump bypass quartile, adjusted mortality and complication rates for patients having off-pump bypass were significantly lower than for the on-pump group (odds ratio [OR] = 0.50; 95% confidence intervals [CI], 0.41-0.61; OR = 0.73; 95% CI, 0.66-0.81, respectively; P < .001); by contrast, for hospitals in the lowest percent off-pump bypass quartile, mortality and complications were similar in off-pump and on-pump groups (OR = 1.10; 95% CI, 0.75-1.63; OR = 0.92; 95% CI, 0.72-1.16, respectively; P > .05).
Outcomes were significantly better for off-pump compared with on-pump coronary artery bypass grafting. Although the benefit of off-pump bypass grafting increased as the relative use of the procedure at a hospital increased, off-pump bypass grafting can be safely implemented across numerous hospitals.
Details
- Title: Subtitle
- Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
- Creators
- Suma H Konety - Division of Cardiovascular Diseases, Department of Internal Medicine, University of California San Francisco, San Francisco, Calif., USA. konetys@medicine.ucsf.eduGary E RosenthalMary S Vaughan-Sarrazin
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.137(5), pp.1116-1123.e1
- Publisher
- United States
- DOI
- 10.1016/j.jtcvs.2008.12.038
- PMID
- 19379976
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Grant note
- HL 07121 / NHLBI NIH HHS
- Language
- English
- Date published
- 05/2009
- Academic Unit
- Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984064189302771
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