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Original Articles: Adult Cardiac

On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in a Cohort of 63,000 Patients

^a Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
^b Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
^c Section of Adult Cardiac Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, University of Houston, Houston, Texas

Accepted for publication March 17, 2009.

^_* Address correspondence to Dr Chu, Division of Cardiothoracic Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (Email: dchumd{at}gmail.com).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: OPCAB does not produce lower postoperative mortality or stroke rates than CABG. Furthermore, OPCAB is associated with longer hospital stays and higher hospital costs.