Use of off-pump and on-pump CABG strategies in current clinical practice: the Clinical Outcomes Assessment Program of the state of Washington.
BACKGROUND
The purpose of this study is to assess clinical outcomes and regional differences in the use of on-pump and off-pump CABG in current clinical practice.


METHODS
Between January 1, 1999, and December 31, 2000, there were 10,429 CABG procedures performed in 16 Washington state hospitals, all of which participate in Clinical Outcomes Assessment Program database. This analysis excluded patients with a history of prior CABG as well as those who underwent emergent surgery. After applying these exclusion criteria, 8402 patients (7169 on-pump and 1233 off-pump CABG procedures) were evaluated and presented as both unadjusted and risk-adjusted outcomes.


RESULTS
Off-pump CABG constituted 14.7% of all surgical revascularization procedures. These varied enormously among individual centers from an incidence of 0% to 68.9%. The use of off-pump CABG was not associated with a decreased risk of risk-adjusted hospital mortality or stroke, but was associated with a reduction in hospital stay > 7 days (OR 0.62, CI 0.51-0.76), ventilator > 24 hours (OR 0.52, CI 0.34-0.81), dialysis (OR 0.34, CI 0.14-0.86), and RBC transfusion (OR 0.5, CI 0.40-0.61).


CONCLUSIONS
Despite its highly variable use, off-pump CABG seems to be judiciously used in current clinical practice in the State of Washington and is associated with a decrease in morbidity in appropriately selected patients.
Aldea
Gabriel S
GS
Division of Cardiothoracic Surgery of the University of Washington School of Medicine, Olympia, WA, USA. aldea@u.washington.edu
Goss
J Richard
JR
Boyle
Edward M
EM
Quinton
Ronald R
RR
Maynard
Charles
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014861:Washington