Economic And Quality Efficiencies Of Off-pump And On-pump Coronary Revascularization: Single Surgeon, Institution Study
Hogan K. Hudgins, Micah C. Kerney, Xiao Han, Patrick T. Roughneen.
University of Texas Medical Branch, Galveston, TX, USA.
Objective: The economic cost of off-pump (OPCAB) versus on-pump (PCAB) coronary artery bypass (CAB) surgery remains widely disputed. Quality, cost-effective treatment is paramount in the practice of cardiac surgery. This study assesses the respective economic and quality efficiencies of OPCAB versus PCAB. Methods: In order to avoid variability in surgical practice, technique, and postoperative care, all patients were treated by a single surgeon at a single institution. Seventy patients from September 2015 through May 2017 who underwent CAB were studied: twenty-one OPCAB and forty-nine PCAB. Data including the total direct operating room (OR) cost of surgery, variable direct OR cost of surgery (OR staff, medical and pump supplies, off-pump stabilizing systems, cardioplegia, OR time, etc.), average number of grafts, postoperative length of stay (ICU and total), blood utilization, and postoperative complications were statistically compared between groups using a 2-sample t-test. Results: Total direct OR costs and variable direct OR costs to the patient were substantially less in the OPCAB group versus the PCAB group (p < 0.001, p < 0.002, respectively) [Figure 1]. In addition, OR time was less in the OPCAB group, saving $540/case (p < 0.001). The number of grafts per patient was less in the OPCAB group (2.3 ± 0.96 versus 3.1 ± 0.91; p < 0.001). Postoperative ICU length of stay between the two groups were similar (off-pump: 2.1 ± 1.3 versus on-pump: 2.3 ± 2.2 days; p < 0.36), as well as total postoperative length of stay (off-pump: 6.5 ± 3.6 versus on-pump: 6.7 ± 2.2 days; p < 0.49). Blood products were utilized in 52% of the OPCAB group versus 73% of the PCAB group. Postoperative complication rates were equivalent between the two groups. There was one in-hospital mortality in each group. Conclusions: Decreased OR time, perfusion costs, and blood utilization make OPCAB more cost efficient. Fewer grafts and time in the OPCAB group inadequately accounts for this cost efficiency. Length of stay and quality metrics were similar. However, utilization of OPCAB as a more cost-effective therapy remains an individual surgeon decision.
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