Costs, clinical outcomes, and health-related quality of life of off-pump vs. on-pump coronary bypass surgery.
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 (60pts) or on-pump surgery (42pts) 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 euro vs. on-pump 9.872+/-1.299 euro, 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.


CONCLUSIONS
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.
Kastanioti
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Economic Department, University Hospital of Ioannina 1, L. Stavrou Niarchou 45500 Ioannina, Greece. catherinekastanioti@yahoo.gr
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D005260:Female; D006115:Greece; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011788:Quality of Life