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Ann Thorac Surg 1999;68:2237-2242
© 1999 The Society of Thoracic Surgeons
a Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom
Address reprint requests to Dr Angelini, Bristol Heart Institute, Bristol Royal Infirmary, BS2 8HW, Bristol, UK
e-mail: g.d.angelini{at}bristol.ac.uk
Background. Emphasis on cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. The revival of interest in off-pump (beating heart) coronary artery bypass surgery may 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 cardiopulmonary bypass and cardioplegic arrest or off-pump surgery. Variable and fixed direct 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- and intraoperative patient variables. Off-pump surgery was significantly less costly than conventional on-pump surgery with respect to operating materials, bed occupancy, and transfusion requirements (total mean cost per patient: on pump, $3,731.6 ± 1,169.7 vs off-pump, $2,615.13 ± 953.6; p < 0.001). Morbidity was significantly higher in the on-pump group, which was reflected in an increased cost.
Conclusions. Off-pump revascularization offers a safe, cost-effective alternative to conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest.
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