Abstract
Background We evaluated the impact of intraoperative conversion from off-pump coronary artery bypass graft surgery (OPCAB) to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) on rates of postoperative 30-day hospital readmissions. Methods Using data from the California CABG outcomes reporting program, postoperative 30-day hospital readmissions were compared among CCB, OPCAB, and intraoperative conversions from OPCAB to CCB (IOC) for isolated CABG operations. A multivariable logistic regression model with inverse propensity for OPCAB weighting was used to compute risk-adjusted readmission rates. General linear models were used to test the differences in propensity-weighted and risk-adjusted readmission rates among CCB, OPCAB, and IOC cases. Results Among 22,389 isolated CABGs, 5,125 (22.9%) were OPCAB; 595 (11.6%) OPCAB patients had intraoperative conversion from OPCAB to CCB (IOC). The patients who underwent IOC had a higher prevalence of preoperative heart failure, left main coronary artery disease, and 3 or greater diseased coronary vessels compared with OPCAB without conversion. The risk-adjusted readmission model (weighted for OPCAB propensity) showed OPCAB without conversion was not associated with any increase in readmission rates when compared with CCB (adjusted odds ratio [AOR]; 1.02, 95% confidence interval [CI], 0.963 to 1.081) but OPCAB with IOC had a significant effect on readmission (AOR, 1.258; 95% CI, 1.122 to 1.411, p < 0.0001). The OPCAB with IOC was also associated with a higher proportion of readmissions due to postoperative infection (19.1% vs 11.9% of readmissions for CCB). Conclusions Intraoperative conversions from OPCAB to CCB are associated with a higher rate of postoperative hospital readmission and infection.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 16-22 |
| Number of pages | 7 |
| Journal | Annals of Thoracic Surgery |
| Volume | 98 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2014 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission. / Li, Zhongmin; Amsterdam, Ezra A; Danielsen, Beate; Hoegh, Holly; Young, J Nilas; Armstrong, Ehrin J.
In: Annals of Thoracic Surgery, Vol. 98, No. 1, 2014, p. 16-22.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission
AU - Li, Zhongmin
AU - Amsterdam, Ezra A
AU - Danielsen, Beate
AU - Hoegh, Holly
AU - Young, J Nilas
AU - Armstrong, Ehrin J.
PY - 2014
Y1 - 2014
N2 - Background We evaluated the impact of intraoperative conversion from off-pump coronary artery bypass graft surgery (OPCAB) to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) on rates of postoperative 30-day hospital readmissions. Methods Using data from the California CABG outcomes reporting program, postoperative 30-day hospital readmissions were compared among CCB, OPCAB, and intraoperative conversions from OPCAB to CCB (IOC) for isolated CABG operations. A multivariable logistic regression model with inverse propensity for OPCAB weighting was used to compute risk-adjusted readmission rates. General linear models were used to test the differences in propensity-weighted and risk-adjusted readmission rates among CCB, OPCAB, and IOC cases. Results Among 22,389 isolated CABGs, 5,125 (22.9%) were OPCAB; 595 (11.6%) OPCAB patients had intraoperative conversion from OPCAB to CCB (IOC). The patients who underwent IOC had a higher prevalence of preoperative heart failure, left main coronary artery disease, and 3 or greater diseased coronary vessels compared with OPCAB without conversion. The risk-adjusted readmission model (weighted for OPCAB propensity) showed OPCAB without conversion was not associated with any increase in readmission rates when compared with CCB (adjusted odds ratio [AOR]; 1.02, 95% confidence interval [CI], 0.963 to 1.081) but OPCAB with IOC had a significant effect on readmission (AOR, 1.258; 95% CI, 1.122 to 1.411, p < 0.0001). The OPCAB with IOC was also associated with a higher proportion of readmissions due to postoperative infection (19.1% vs 11.9% of readmissions for CCB). Conclusions Intraoperative conversions from OPCAB to CCB are associated with a higher rate of postoperative hospital readmission and infection.
AB - Background We evaluated the impact of intraoperative conversion from off-pump coronary artery bypass graft surgery (OPCAB) to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) on rates of postoperative 30-day hospital readmissions. Methods Using data from the California CABG outcomes reporting program, postoperative 30-day hospital readmissions were compared among CCB, OPCAB, and intraoperative conversions from OPCAB to CCB (IOC) for isolated CABG operations. A multivariable logistic regression model with inverse propensity for OPCAB weighting was used to compute risk-adjusted readmission rates. General linear models were used to test the differences in propensity-weighted and risk-adjusted readmission rates among CCB, OPCAB, and IOC cases. Results Among 22,389 isolated CABGs, 5,125 (22.9%) were OPCAB; 595 (11.6%) OPCAB patients had intraoperative conversion from OPCAB to CCB (IOC). The patients who underwent IOC had a higher prevalence of preoperative heart failure, left main coronary artery disease, and 3 or greater diseased coronary vessels compared with OPCAB without conversion. The risk-adjusted readmission model (weighted for OPCAB propensity) showed OPCAB without conversion was not associated with any increase in readmission rates when compared with CCB (adjusted odds ratio [AOR]; 1.02, 95% confidence interval [CI], 0.963 to 1.081) but OPCAB with IOC had a significant effect on readmission (AOR, 1.258; 95% CI, 1.122 to 1.411, p < 0.0001). The OPCAB with IOC was also associated with a higher proportion of readmissions due to postoperative infection (19.1% vs 11.9% of readmissions for CCB). Conclusions Intraoperative conversions from OPCAB to CCB are associated with a higher rate of postoperative hospital readmission and infection.
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U2 - 10.1016/j.athoracsur.2014.03.040
DO - 10.1016/j.athoracsur.2014.03.040
M3 - Article
C2 - 24841542
AN - SCOPUS:84903840991
VL - 98
SP - 16
EP - 22
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -