Outcomes/Effectiveness Research

Surgeon experience with on-pump coronary bypass surgery affects outcome of patients undergoing off-pump surgery

In New York State, the percentage of coronary artery bypass graft (CABG) surgeries performed on a beating heart increased from 3 percent in 1997 to 27 percent in 2000. Conventional CABG surgery generally uses an on-pump procedure where blood is pumped out of the stopped heart (cardiopulmonary bypass, CPB) so that the surgeon can work on the heart while the blood circulates through an external pump to other parts of the body. However, CPB initiates a systemic inflammatory response that may cause problems in over a third of patients. Although use of off-pump CABG surgery may avoid many of these problems, operating on a beating heart is technically more difficult.

A recent study supported by the Agency for Healthcare Research and Quality (HS13617) found that surgeon experience with on-pump CABG improves patient outcomes, but experience with the technically more difficult off-pump surgery on a beating heart does not.

Laurent G. Glance, M.D., of the University of Rochester School of Medicine and Dentistry, and colleagues analyzed data from the New York State Cardiac Surgery database to determine whether the impact of surgeon experience on off-pump surgery was significantly different than that for on-pump surgery. The study sample consisted of 36,930 patients undergoing CABG surgery between 1998 and 1999, performed by 181 surgeons at 33 hospitals. The researchers found no association between the number of CABG procedures performed off-pump by an individual surgeon and in-hospital mortality rates. Researchers also found that surgeons performing a high volume of on-pump CABG procedures had significantly lower risk-adjusted mortality rates among their patients compared to surgeons performing lower volumes of such procedures. Dr. Glance cautions, however, this study was limited in scope.

See "The relation between surgeon volume and outcome following off-pump vs. on-pump coronary artery bypass graft surgery," by Dr. Glance, Andrew W. Dick, Ph.D., Turner M. Osler, M.D., and Dana B. Mukamel, Ph.D., in the August 2005 Chest 128, pp. 829-837.

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