Trends in utilization of off-pump coronary artery bypass graft surgery in the US

ABSTRACT.Coronary artery bypass graft (CABG) surgery is the mainstay for surgical treatment of coronary artery disease. CABG is performed in one of two ways: (1) while the heart is temporarily arrested, and a patient receives cardiopulmonary bypass (‘on pump’); or (2) without cardiopulmonary bypass with the heart still beating (‘off pump’). This observational study using data from 2004-2015 from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) examined trends in utilization and outcomes (in-hospital mortality, length of stay (LOS), hospital costs, and selected post-operative complications associated with on and off pump CABG. Overall, there was a declining trend in the number of CABG procedures. Off-pump procedure patients had significantly higher unadjusted mortality rates and longer LOS, but without significantly higher costs. There was a lower risk of post-operative stroke associated with off-pump procedures, but an increased occurrence of post-operative sepsis. One possible explanation is that more patients may be receiving angioplasty, which may have increased the pool of CABG patients with higher risk factors. Hospital administrators may use this information to optimize patient outcomes in cardiovascular surgery units. Future research should seek to control for patient level risk factors in the selection of surgical procedure.KEYWORDS: Coronary artery diseasecoronary artery bypass graftCABGcardiopulmonary bypassoff-pump coronary artery bypassutilizationHCUP-NIS Disclosure statementNo potential conflict of interest was reported by the author(s).Authorship contribution statementCatherine Z. Baumgardner, PhD: Conceptualization (supporting); Writing – original draft (equal); Writing – review and editing (equal); Project administration (supporting); Supervision (supporting).Amber Schilling, PharmD: Data curation (supporting); Formal analysis (equal); Writing – original draft (equal); Writing – review & editing (equal).Diane Spokus, PhD: Writing – original draft (equal); Writing – review & editing (equal).Zachary Henderson, MHA: Writing – original draft (equal); Writing – review & editing (equal).Mark Suzuki, MD: Writing – review & editing (equal).Christopher S. Hollenbeak, PhD: Conceptualization (lead); Data curation (lead); Formal analysis (equal); Project administration (lead); Supervision (lead)Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.Notes on contributorsCatherine Z. BaumgardnerDr Catherine Z. Baumgardner is a leadership scholar and Teaching Professor at The Pennsylvania State University. Her research focuses on leadership and organization development in healthcare, with a special emphasis on physician leaders.Amber SchillingDr Amber Schilling is a pharmacist who works as an independent consultant on a wide variety of health outcomes and value-based research projects. She has partnered with clients in both industry and academia. She resides in the Washington, DC metro area.Diane SpokusDr Diane Spokus is a Teaching Professor in the Department of Health Policy and Administration at The Pennsylvania State University. She also holds the Master Certified Health Education Specialist credential and serves on a hospital board. Her research focuses on healthcare workforce training and development with specific interests in aging policies.Zachary HendersonZachary Henderson, MHA, FACHE, CMPE is a Regional Operations Manager working for Geisinger Health System. He has over a decade of experience leading a variety of specialty practices. His operational knowledge is rooted in streamlining efficient processes and building a team culture to drive results.Mark SuzukiDr Mark Suzuki is board certified in Cardiothoracic and General Surgery and has specialized clinical training in both cardiothoracic and cardiovascular surgery. He is affiliated with Piedmont Augusta, University Health System.Christopher S. HollenbeakDr Christopher S. Hollenbeak is a health economist and Professor and Department head in Health Policy and Administration at The Pennsylvania State University. His research focuses on value and outcomes in healthcare.