Abstract
Objective: To compare the clinical and procedural characteristics, and operative mortality in patients undergoing off-pump coronary artery bypass surgery (OPCAB) and conventional coronary bypass surgery (CCB) among California hospitals, using data from the 2003 and 2004 California Coronary Artery Bypass Graft Surgery (CABG) Outcomes Reporting Program (CCORP). Methods: State mandated data from 121 hospitals that performed isolated CABG during 2003 and 2004 were analyzed, excluding patients with emergent or prior CABG. Patient characteristics associated with OPCAB were identified by multivariate logistic regression analysis. Predicted mortality was calculated using a multivariate model. Correlation between hospital OPCAB volume, OPCAB/CCB volume ratio and hospital risk-adjusted mortality rates was assessed. Results: OPCAB comprised 23% (8,139) of all isolated CABGs, with significant variation in volume among hospitals (median: 29; range 0–1,065). OPCAB was less likely in Caucasians compared with non-Caucasians (adjusted odds ratio [AOR]=0.85, 0.80–0.90), diabetics compared with nondiabetics (AOR 0.93, 0.87–0.98), those with myocardial infarction (MI) 1–7 days prior to CABG compared to no MI (AOR 0.87, 0.81–0.94), and in patients with ≥3 diseased vessels compared with 1 or 2-vessel disease (AOR 0.46, 0.44–0.49). However, OPCAB was more likely in those with peripheral arterial disease (PAD) compared with no PAD (AOR 1.16, 1.07–1.25), or cerebrovascular disease (CVD) compared with no CVD (AOR 1.14 1.03–1.26). OPCAB was associated with a significantly lower risk for observed operative mortality compared with CCB (1.84% vs. 2.49%, p<0.0001), which persisted after adjustment for 23 preoperative factors associated with operative mortality (AOR 0.67, p<0.0001). However, neither hospital OPCAB volume nor OPCAB/CCB volume ratio were associated with hospital risk adjusted operative mortality (p=0.324 and p=0.547, respectively.) Conclusion: OPCAB patients had generally better risk profiles associated with their lower predicted and observed operative mortality. But OPCAB results had no significant impact on hospital level risk-adjusted operative mortality.
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