Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission

Zhongmin Li, Ezra A Amsterdam, Beate Danielsen, Holly Hoegh, J Nilas Young, Ehrin J. Armstrong

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)16-22
Number of pages7
JournalAnnals of Thoracic Surgery
Volume98
Issue number1
DOIs
StatePublished - 2014

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Patient Readmission
Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Transplants
Cardiopulmonary Bypass
Logistic Models
Odds Ratio
Confidence Intervals

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 journalArticle

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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.",
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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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