In a finding with far-reaching implications for less invasive forms of coronary artery bypass surgery, Solucient's researchers discovered that so-called off-pump, or "beating heart," surgery may not yield the shorter stays and lower costs that are touted widely by its proponents.
Until the mid-1990s, heart surgeons performed nearly all coronary bypass procedures while patients were hooked up to a machine to bypass the heart and lungs. Recent advances in surgical techniques and equipment have allowed surgeons to operate while the heart continues to beat on its own, eliminating the need for the machines. Studies have associated the newer procedure with improved outcomes-less need for blood products, fewer wound infections and decreased cognitive problems after surgery, in addition to lower costs and shorter stays, according to Solucient, Evanston, Ill.
Solucient found stunningly different results. Across all Medicare patients, those receiving off-pump surgery in 1999 and 2000 had longer hospital stays and higher costs than patients undergoing the traditional bypass surgery. That finding holds for the 100 top heart hospitals as well, although the benchmark hospitals to be sure have better patient outcomes than the nonwinners whether using off-pump or the on-pump method, according to Solucient's research.
The finding points toward a need for more research, including determining a cause of the ambiguous outcomes, says Jean Chenoweth, executive director of Solucient.
Joseph Cunningham, M.D., chairman of the department of surgery at Maimonides Medical Center in New York, a facility where roughly 40% of all bypass procedures are performed off-pump, says surgeons there see "no difference" between the two procedures in costs and length of stay, although there may be other benefits to off-pump surgery.
Cunningham adds: "We do it because we have to do it. The customer demands it."