A multicenter comparison of intraaortic balloon pump utilization in isolated coronary artery bypass graft surgery

Abstract

Background Single-center studies suggest substantial variation in intraaortic balloon pump (IABP) utilization. Our purpose is to examine IABP utilization over time and across medical centers. Methods This was a prospective cohort of 29,961 consecutive patients undergoing isolated coronary artery bypass graft surgery, between 1995 and 2000, at 10 centers (eight in northern New England and two in Canada). Results A total of 2,678 (8.9%) patients received an IABP. The rate of preoperative IABP insertion was 6.3%, and that of intra- or postoperative insertion was 2.6%. During the 6 years, IABP use increased from 7.0% to 10.3% ( p trend <0.001). Preoperative IABP insertion increased from 5.4% to 7.8% ( p trend < 0.001). There was no significant increase in intra-/postoperative IABP insertion 1.7% to 3.4% ( p trend = 0.34). Adjustment for changes in patient and disease characteristics did not substantially alter these results. The rate of IABP use varied substantially by center, from 5.9% to 16.4% ( p < 0.001). Adjustment for patient and disease characteristics resulted in variation from 4.8% to 12.8% across the 10 centers ( p < 0.001). The adjusted rates of preoperative IABP insertion varied from 3.6% to 13.7% ( p < 0.001), and the rates of intra-/postoperative IABP insertion ranged from 1.0% to 5.2% ( p < 0.001). There was no significant correlation between the rates of preoperative and intra-/postoperative IABP use (r s = 0.085, p = 0.815). Conclusions During the 6 years, there was a 47% increase in the rate of IABP utilization. Even after adjustment, there was almost threefold variation in IABP use across centers. This variation likely reflects lack of consensus on the appropriate use of the IABP in CABG patients.