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Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
J Thorac Cardiovasc Surg. 2009 May; 137(5):1116-23.e1.JT

Abstract

OBJECTIVES

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Division of Cardiovascular Diseases, Department of Internal Medicine, University of California San Francisco, San Francisco, Calif., USA. konetys@medicine.ucsf.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

19379976

Citation

Konety, Suma H., et al. "Surgical Volume and Outcomes of Off-pump Coronary Artery Bypass Graft Surgery: Does It Matter?" The Journal of Thoracic and Cardiovascular Surgery, vol. 137, no. 5, 2009, pp. 1116-23.e1.
Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter? J Thorac Cardiovasc Surg. 2009;137(5):1116-23.e1.
Konety, S. H., Rosenthal, G. E., & Vaughan-Sarrazin, M. S. (2009). Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter? The Journal of Thoracic and Cardiovascular Surgery, 137(5), 1116-e1. https://doi.org/10.1016/j.jtcvs.2008.12.038
Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical Volume and Outcomes of Off-pump Coronary Artery Bypass Graft Surgery: Does It Matter. J Thorac Cardiovasc Surg. 2009;137(5):1116-23.e1. PubMed PMID: 19379976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter? AU - Konety,Suma H, AU - Rosenthal,Gary E, AU - Vaughan-Sarrazin,Mary S, Y1 - 2009/03/25/ PY - 2007/04/05/received PY - 2008/12/04/revised PY - 2008/12/27/accepted PY - 2009/4/22/entrez PY - 2009/4/22/pubmed PY - 2009/5/22/medline SP - 1116 EP - 23.e1 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 137 IS - 5 N2 - OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/19379976/Surgical_volume_and_outcomes_of_off_pump_coronary_artery_bypass_graft_surgery:_Does_it_matter L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(09)00034-8 DB - PRIME DP - Unbound Medicine ER -