Safety and cost-effectiveness of MIDCABG in high-risk CABG patients

Dario F. Del Rizzo, Walter D Boyd, Richard J. Novick, F. Neil McKenzie, Nemish D. Desai, Alan H. Menkis

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background. Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. Methods. Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 ± 11.6 versus 63.3 ± 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p < 0.0001; peripheral vascular disease, 33.3% versus 12.2%, p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0% versus 17.0%, p = 0.07; urgent operation, 86.6% versus 46.3%, p < 0.0001; and redo operation, 20.0% versus 0%, p = 0.003. Results. There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 ± 0.5 days in HR patients versus 1.6 ± 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 ± 1.8 versus 7.3 ± 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 ± 1.2 days (versus the observed stay of 1.1 ± 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 ± 1.5 days (versus the observed stay of 6.1 ± 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1% versus 0%, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%. Conclusions. Myocardial revascularization without cardiopulmonary bypass appears to be a safe and costeffective therapeutic modality for HR patients requiring myocardial revascularization.

Original languageEnglish (US)
Pages (from-to)1002-1007
Number of pages6
JournalAnnals of Thoracic Surgery
Volume66
Issue number3
DOIs
StatePublished - Sep 1998
Externally publishedYes

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Cost-Benefit Analysis
Safety
Myocardial Revascularization
Costs and Cost Analysis
Cardiopulmonary Bypass
Coronary Artery Bypass
Ontario
Intensive Care Units
Length of Stay
Peripheral Vascular Diseases
Stroke Volume
Chronic Obstructive Pulmonary Disease
Heart Failure
Stroke
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Del Rizzo, D. F., Boyd, W. D., Novick, R. J., McKenzie, F. N., Desai, N. D., & Menkis, A. H. (1998). Safety and cost-effectiveness of MIDCABG in high-risk CABG patients. Annals of Thoracic Surgery, 66(3), 1002-1007. https://doi.org/10.1016/S0003-4975(98)00660-2

Safety and cost-effectiveness of MIDCABG in high-risk CABG patients. / Del Rizzo, Dario F.; Boyd, Walter D; Novick, Richard J.; McKenzie, F. Neil; Desai, Nemish D.; Menkis, Alan H.

In: Annals of Thoracic Surgery, Vol. 66, No. 3, 09.1998, p. 1002-1007.

Research output: Contribution to journalArticle

Del Rizzo, DF, Boyd, WD, Novick, RJ, McKenzie, FN, Desai, ND & Menkis, AH 1998, 'Safety and cost-effectiveness of MIDCABG in high-risk CABG patients', Annals of Thoracic Surgery, vol. 66, no. 3, pp. 1002-1007. https://doi.org/10.1016/S0003-4975(98)00660-2
Del Rizzo DF, Boyd WD, Novick RJ, McKenzie FN, Desai ND, Menkis AH. Safety and cost-effectiveness of MIDCABG in high-risk CABG patients. Annals of Thoracic Surgery. 1998 Sep;66(3):1002-1007. https://doi.org/10.1016/S0003-4975(98)00660-2
Del Rizzo, Dario F. ; Boyd, Walter D ; Novick, Richard J. ; McKenzie, F. Neil ; Desai, Nemish D. ; Menkis, Alan H. / Safety and cost-effectiveness of MIDCABG in high-risk CABG patients. In: Annals of Thoracic Surgery. 1998 ; Vol. 66, No. 3. pp. 1002-1007.
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abstract = "Background. Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. Methods. Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 ± 11.6 versus 63.3 ± 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0{\%} versus 26.8{\%}, p = 0.02; diabetes, 20.0{\%} versus 24.4{\%}, p = 0.7; prior stroke, 33.3{\%} versus 7.4{\%}, p = 0.03; chronic obstructive pulmonary disease, 60.0{\%} versus 9.8{\%}, p < 0.0001; peripheral vascular disease, 33.3{\%} versus 12.2{\%}, p = 0.03, congestive heart failure, 26.6{\%} versus 9.8{\%}, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0{\%} versus 17.0{\%}, p = 0.07; urgent operation, 86.6{\%} versus 46.3{\%}, p < 0.0001; and redo operation, 20.0{\%} versus 0{\%}, p = 0.003. Results. There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 ± 0.5 days in HR patients versus 1.6 ± 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 ± 1.8 versus 7.3 ± 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 ± 1.2 days (versus the observed stay of 1.1 ± 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 ± 1.5 days (versus the observed stay of 6.1 ± 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1{\%} versus 0{\%}, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50{\%}. Conclusions. Myocardial revascularization without cardiopulmonary bypass appears to be a safe and costeffective therapeutic modality for HR patients requiring myocardial revascularization.",
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T1 - Safety and cost-effectiveness of MIDCABG in high-risk CABG patients

AU - Del Rizzo, Dario F.

AU - Boyd, Walter D

AU - Novick, Richard J.

AU - McKenzie, F. Neil

AU - Desai, Nemish D.

AU - Menkis, Alan H.

PY - 1998/9

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N2 - Background. Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. Methods. Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 ± 11.6 versus 63.3 ± 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p < 0.0001; peripheral vascular disease, 33.3% versus 12.2%, p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0% versus 17.0%, p = 0.07; urgent operation, 86.6% versus 46.3%, p < 0.0001; and redo operation, 20.0% versus 0%, p = 0.003. Results. There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 ± 0.5 days in HR patients versus 1.6 ± 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 ± 1.8 versus 7.3 ± 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 ± 1.2 days (versus the observed stay of 1.1 ± 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 ± 1.5 days (versus the observed stay of 6.1 ± 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1% versus 0%, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%. Conclusions. Myocardial revascularization without cardiopulmonary bypass appears to be a safe and costeffective therapeutic modality for HR patients requiring myocardial revascularization.

AB - Background. Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. Methods. Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 ± 11.6 versus 63.3 ± 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p < 0.0001; peripheral vascular disease, 33.3% versus 12.2%, p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0% versus 17.0%, p = 0.07; urgent operation, 86.6% versus 46.3%, p < 0.0001; and redo operation, 20.0% versus 0%, p = 0.003. Results. There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 ± 0.5 days in HR patients versus 1.6 ± 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 ± 1.8 versus 7.3 ± 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 ± 1.2 days (versus the observed stay of 1.1 ± 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 ± 1.5 days (versus the observed stay of 6.1 ± 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1% versus 0%, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%. Conclusions. Myocardial revascularization without cardiopulmonary bypass appears to be a safe and costeffective therapeutic modality for HR patients requiring myocardial revascularization.

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