title: Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes.
abstract: BACKGROUND
  Pulmonary artery catheters (PAC) are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG) surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG.
  
  
  METHODS
  1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group) and 908 received no PAC therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison.
  
  
  RESULTS
  The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001) and epinephrine (7.7% vs. 2.6%; P<0.001). In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004). PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes.
  
  
  CONCLUSIONS
  There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery.
authors.affiliation: Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, Inner Mongolia Medical University, Huhhot Inner Mongolia, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of cardio-thoracic surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Biostatistical Unit, Capital Medical University, Beijing, China.
authors.forename: Sipeng
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Hushan
authors.initials: H
authors.lastname: Ao
mesh_terms: D000368:Aged; D062906:Cardiac Catheters / Q000191:economics*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000191:economics*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics*; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011651:Pulmonary Artery / Q000601:surgery; D018570:Risk Assessment; D016896:Treatment Outcome