Our objective was to assess surgical outcomes between male and female patients undergoing off-pump coronary artery bypass grafting (CABG). The study was conducted from a 10-year hospitalization cohort (n = 11,230) in which the data were collected prospectively. Inclusion criteria included an off-pump CABG-only procedure. There were 526 men and 250 women included in the study. Fourteen potential confounding risk factors and 14 outcome variables were examined. Six potential risk factors were found to be significantly different between men and women. Men were younger (P = 0.014), had a larger body surface area (P < 0.001), a higher creatinine level (P < 0.001), required more grafts (P < 0.001), and were more likely to have a cerebrovascular history (P = 0.020) and a history of tobacco use (P < or = 0.001). Logistic regression analysis showed that even after controlling for age, body surface area, creatinine level, number of grafts, and tobacco history, women had longer length of hospitalization (odds ratio, 1.97; 95% confidence interval, 1.28-3.04, P = 0.002) and more sternal wound complications than men (odds ratio, 1.07; 95% confidence interval, 1.01-2.11, P = 0.028) after off-pump CABG. Although not statistically different, women had lower operative mortality than men after off-pump CABG (0.8% [2 of 10] compared with 1.5% [8 of 10], respectively). Despite women requiring a longer hospitalization and having a greater incidence of sternal wound infections than men, there was no significant difference in mortality.