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Evidence and use of less invasive co...

The Johns Hopkins University.

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Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data./
Author:	Sedrakyan, Art.
Description:	150 p.
Notes:	Adviser: Albert Wu.
Contained By:	Dissertation Abstracts International69-12B.
Subject:	Health Sciences, Health Care Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoeng/servlet/advanced?query=3339970
ISBN:	9780549939290

Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data.
Sedrakyan, Art.

Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data. - 150 p.

Adviser: Albert Wu.

Thesis (Ph.D.)--The Johns Hopkins University, 2009.

The problem. There is growing enthusiasm for less invasive coronary artery bypass grafting (CABG) performed off-pump (without cardiopulmonary-bypass). We determined the association of off-pump surgery with occurrence of adverse outcomes. In addition, we evaluated the use of less invasive CABG in the US.

ISBN: 9780549939290Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data.
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020 $a 9780549939290
035 $a (UMI)AAI3339970
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100 1 $a Sedrakyan, Art. $3 1025312
245 1 0 $a Evidence and use of less invasive coronary bypass surgery: A technology assessment and evaluation using national data.
300 $a 150 p.
500 $a Adviser: Albert Wu.
500 $a Source: Dissertation Abstracts International, Volume: 69-12, Section: B, page: 7451.
502 $a Thesis (Ph.D.)--The Johns Hopkins University, 2009.
520 $a The problem. There is growing enthusiasm for less invasive coronary artery bypass grafting (CABG) performed off-pump (without cardiopulmonary-bypass). We determined the association of off-pump surgery with occurrence of adverse outcomes. In addition, we evaluated the use of less invasive CABG in the US.
520 $a Methods. Evidence: We searched the MEDLINE, EMBASE and the Cochrane Register 1980-2007(December). We also searched the reference lists of randomized clinical trials (RCT) and reviews. Study selection: RCTs comparing off-pump surgery to on-pump CABG. Data extraction: We independently searched for studies, read abstracts and abstracted all data. Data synthesis: Risk estimates were obtained using fixed or random effects meta-analyses. Evaluation of use: On- and off-pump CABG were identified in HCUP, NIS database including 250 hospitals. Procedures and diagnoses were based on ICD-9-CM coding. A multivariable model was constructed including variables that are clinically and statistically significant (GLIMMIX procedure in SAS).
520 $a Results. Evidence: There were 5,040 patients enrolled in 48 RCTs (mean age 62, 22% female). No study reported information on race. Off-pump CABG was associated with 55% reduction in stroke, 31% in atrial fibrillation and 48% in wound infection. This translated into avoidance of 12, 80 and 40 events per 1000 CABG accordingly. However, there were fewer grafts and more re-interventions (20-per-1000) with off-pump CABG.
520 $a Evaluation of use: There were 63,435 patients in 235 hospitals (mean age 65, 31% female). Off-pump use was 24.8% and variability range was 0% to 95%. Cluster level variables such as volume, size and hospital ownership were the strongest predictors of use. Large volume hospitals had 48% lower odds while private, investor owned hospitals had 2.66 times higher odds of using off-pump. Known characteristics explained very small portion of variation among hospitals.
520 $a Conclusions. Off-pump CABG is associated with reduced risk of stroke, atrial fibrillation and infections as compared to on-pump CABG. Evidence should be generalized taking into account RCT limitations, learning curve, propensity to perform fewer grafts and likely re-interventions following off-pump surgery. The variation in care among hospitals is not explained by patient characteristics and is only slightly explained by hospital characteristics. This needs careful reflection and policy level assessment/intervention.
590 $a School code: 0098.
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Health Sciences, Medicine and Surgery. $3 1017756
650 4 $a Health Sciences, Public Health. $3 1017659
690 $a 0564
690 $a 0573
690 $a 0769
710 2 $a The Johns Hopkins University. $3 1017431
773 0 $t Dissertation Abstracts International $g 69-12B.
790 $a 0098
790 1 0 $a Wu, Albert, $e advisor
791 $a Ph.D.
792 $a 2009
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoeng/servlet/advanced?query=3339970