On-pump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients.

Abstract

The best approach to surgical myocardial revascularization remains controversial. We compared outcomes of conventional on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass (OPCAB) by using a nonvoluntary national database. In the 2004 Nationwide Inpatient Sample database, we identified 63,047 discharge records of patients who underwent CABG (n = 48,658) or OPCAB (n = 14,389). We analyzed seven preoperative variables, including the Deyo comorbidity index and five outcome measures. Multivariable logistic regression was used to identify independent predictors of outcomes. CABG and OPCAB patients had similar demographics and comorbidities. They also had similar rates of in-hospital mortality (3.0% vs 3.2%; p = 0.14) and postoperative stroke (1.8% vs 1.7%; p = 0.53). However, OPCAB patients had longer hospital stays (10.2 +/- 9.4 vs 9.9 +/- 8.5 days; p < 0.0001) and higher hospital costs ($38,793 +/- $30,830 vs $37,806 +/- $28,705; p = 0.0005) than CABG patients. Multivariable regression analysis showed that OPCAB independently predicted 0.6 more days of hospital stay (95% confidence interval [CI], 0.4 to 0.8 day; R(2) = 0.09; p < 0.0001) and $1,497 more in hospital costs (95% CI, $779 to $2,216; R(2) = 0.09; p < 0.01) per patient. OPCAB does not produce lower postoperative mortality or stroke rates than CABG. Furthermore, OPCAB is associated with longer hospital stays and higher hospital costs.