Comparative Analysis of Coronary Artery Bypass: Costs of Off-Pump vs. Conventional Techniques with Variable Bonded Circuits and Drug Strategies
Abstract
As baby boomers age, estimated to reach 78.8 million Americans over the age of 65 by 2050, their health care costs are skyrocketing. Increased costs in coronary artery bypass surgery have been linked to length of stay (LOS), the inflammatory response, and blood loss related to conventional coronary artery bypass (C-CAB). Off-pump coronary artery bypass (OPCAB) has become a popular alternative to C-CAB. Utilizing proximal connector devices has truly made this option "clampless." If detrimental outcomes can be linked to cross clamping, the use of cardiopulmonary bypass (CPB) may diminish. When the use of CPB is necessary, there are a number of circuit coatings available, along with drugs like Aprotinin, to decrease the inflammatory response, and Amicar, to decrease the amount of blood loss, all due to the exposure of the body to CPB. This study compares the cost and LOS involved with OPCAB vs. C-CAB, including a comparison of the inflammatory response and blood loss with each drug regime and circuit coating used. Analysis of the data revealed no significant difference in several cost areas. The total operating room (O.R.) costs showed that the C-CAB with Aprotinin group's mean cost was $8559.13 (statistical difference [SD] of $1056.61; 95% confidence interval[CI] was reported as $8164.58 for lower bound and $8953.67 for the upper bound). The C-CAB with Amicar group's mean cost was $9096.40 (SD of $1859.16; 95% CI was reported as $8402.17 for lower bound and $9790.62 for upper bound). The OPCAB group's mean cost was reported as $8442.86 (SD of $1482.63; 95% CI was reported as $7621.81 for lower bound and $9263.92 for upper bound). The O.R. supply costs showed that the C-CAB with Aprotinin group's mean cost was $3889.66 (SD of$685.91; 95% Cl was reported as $3633.54 for the lower bound and $4145.79 for the upper bound). The C-CAB with Amicar group's mean cost was $3934.30 (SD of $1198.46; 95% CI was reported as $3486. 78 for the lower bound and $4381.81 for the upper bound). The OPCAB group's mean cost was $4014.13 (SD of $1084. 77; 95% CI was reported as $3413.40 for the lower bound and $4614.86 for the upper bound). The pharmacy costs showed that the C-CAB with Aprotinin group's mean cost was $2553.76 (SD of $1305.61; 95% CI was reported as $2066.24 for the lower bound and $3041.29 for the upper bound). The C-CAB with Amicar group's mean cost was $2654.33 (SD of $3502.66; 95% CI was reported as $1346.41 for the lower bound and $3962.25 for the upper bound). The OPCAB group's cost was reported as a mean of $1710.93 (SD of$1147.01; 95% CI was reported as $1075.73 for the lower bound and $2346.13 for the upper bound).