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CLINICAL RESEARCH

A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy

Michael J. Racz, MA^*||||, Edward L. Hannan, PhD^*,*, O. Wayne Isom, MD, Valavanur A. Subramanian, MD, Robert H. Jones, MD, FACC, Jeffrey P. Gold, MD^||, Thomas J. Ryan, MD, FACC^¶, Alan Hartman, MD^#, Alfred T. Culliford, MD^**, Edward Bennett, MD, Robert A. Lancey, MD and Eric A. Rose, MD

^* University at Albany, State University of New York, Albany, New York, USA
New York Hospital-Cornell, New York, New York, USA
Lenox Hill Hospital, New York, New York, USA
Duke University Medical Center, Durham, North Carolina, USA
^|| Montefiore Medical Center, Bronx, New York, USA
^¶ Boston University School of Medicine, Boston, Massachusetts, USA
^# North Shore-LIJ Health System, Manhasset, New York, USA
^** New York University Medical Center, New York, New York, USA
St. Peter's Hospital, Albany, New York, USA
Mary Imogene Bassett Hospital, Cooperstown, New York, USA
Columbia-Presbyterian Medical Center, New York, New York, USA
^|||| Williams College, Williamstown, Massachusetts, USA

Manuscript received June 17, 2003; revised manuscript received September 16, 2003, accepted September 23, 2003.

^* Reprint requests and correspondence: Dr. Edward L. Hannan, Professor and Chair, Dept. of Health Policy, Management, and Behavior, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456, USA.
elh03{at}health.state.ny.us

OBJECTIVES: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk.

BACKGROUND: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small.

METHODS: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9,135 patients) and on-pump CABG surgery (59,044 patients) with median sternotomy from 1997 to 2000 in the state of New York.

RESULTS: Risk-adjusted inpatient mortality was 2.02% for off-pump versus 2.16% for on-pump (p = 0.390). Off-pump patients had lower rates of perioperative stroke (1.6% vs. 2.0%, p = 0.003) and bleeding requiring reoperation (1.6% vs. 2.2%, p < 0.001) and higher rates of gastrointestinal bleeding, perforation, or infarction (1.2% vs. 0.9%, p = 0.003). Off-pump patients had lower postoperative lengths of stay (median 5 days vs. 6 days, p < 0.001). On-pump patients had higher three-year survival (adjusted risk ratio [RR] =1.086, p = 0.045) and higher freedom from death or revascularization (adjusted RR = 1.232, p < 0.001). When analyses were limited to 1999 to 2000, the two-year adjusted hazard ratio for survival was not significant (adjusted RR = 0.99, p = 0.81).

CONCLUSIONS: On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CSRS = Cardiac Surgery Reporting System   HR = hazard ratio   MI = myocardial infarction   PCI = percutaneous coronary intervention   RCT = randomized controlled trial

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