Costs,Clinical Outcomes,and Health-Related Quality of Life of Off-Pump vs. On-Pump Coronary Bypass Surgery

Abstract

Background: Off-pump coronary bypass surgery avoids the potential complications of cardiopulmonary bypass. However, its acceptance depends on medical and economic outcome. The aim of this prospective non-randomised study was to compare functional and economic outcome of off-pump and on-pump surgery at 1-year follow-up.

Methods: 102 patients (pts) treated with either off-pump (60 pts) or on-pump surgery (42 pts) were studied. Pts with left ventricular dysfunction, recent myocardial infarction (< 1 month), renal impairment, valve surgery, previous stroke or coagulopathy were excluded. Variable and fixed costs were obtained for each treatment group during operative and postoperative care. In-hospital endpoints included all-cause mortality and complications (defined as excessive bleeding [> 6 units blood transfusion], peri-operative myocardial infarction, atrial fibrillation, stroke, and infection). All cause mortality; cost-effectiveness and quality of life were assessed 1 year after surgery.

Results: The in-hospital mortality was similar in the two treatment groups. Off-pump group had significantly fewer postoperative complication rate (off-pump 41% vs. on-pump 72%, p = 0.001). The mean in-hospital cost was lower for off-pump surgery (off-pump 6.515 ± 926 € vs. on-pump 9.872 ± 1.299 €, p < 0.0001) as well as the mean length of hospital stay (off-pump 4.93 ± 0.93 days vs. on-pump 6.58 ± 1.04 days, p < 0.0001). At 1 year, all cause mortality, quality of life indices, return to work rate and treatment satisfaction was similar in both groups.

Conclusion: Off-pump myocardial revascularization maintains the advantages of conventional surgery in terms of survival and freedom from cardiac events while reducing the in-hospital cost.

Keywords

Cost-effectiveness analysis Quality of life CABG OPCAB

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