Cost and Outcome of Minimally Invasive Techniques for Coronary Surgery Using Robotic Technology.

Document Type

Article

Publication Date

7-1-2018

Publication Title

Innovations (Phila)

Keywords

Aged; Coronary Artery Bypass/adverse effects; Coronary Artery Bypass/economics; Coronary Artery Bypass/methods; Coronary Artery Bypass/statistics & numerical data; Female; Hospital Costs/statistics & numerical data; Humans; Length of Stay/statistics & numerical data; Male; Middle Aged; Minimally Invasive Surgical Procedures/adverse effects; Minimally Invasive Surgical Procedures/economics; Minimally Invasive Surgical Procedures/methods; Minimally Invasive Surgical Procedures/statistics & numerical data; Postoperative Complications/epidemiology; Retrospective Studies; Robotic Surgical Procedures/adverse effects; Robotic Surgical Procedures/economics; Robotic Surgical Procedures/methods; Robotic Surgical Procedures/statistics & numerical data; Treatment Outcome

Abstract

OBJECTIVE: Totally endoscopic coronary artery bypass (TECAB) with robotic distal anastomosis and robotic-assisted minimally invasive coronary artery bypass (RA-MIDCAB) with robotic internal mammary artery harvest and direct hand-sewn distal anastomosis via an anterior thoracotomy have both been reported as safe and efficacious. We compared hospital cost and short-term outcomes between these techniques.

METHODS: Patients who underwent robotic-assisted minimally invasive single-vessel Coronary artery bypass grafting (2011-2014) were retrospectively reviewed. One hundred consecutive patients underwent either TECAB (n = 50) or RA-MIDCAB (n = 50). The two groups were sequential with TECAB performed by one surgeon in the first portion of the study interval and RA-MIDCAB by another surgeon in the latter. Demographics, short-term outcomes, and hospital cost data were compared between the two groups.

RESULTS: Patient demographics and preoperative risk factors were similar between the TECAB and RA-MIDCAB groups, as total operating room time. Cardiopulmonary bypass was used for 56% of TECAB and 0% of RA-MIDCAB cases (P < 0.001). Intensive care unit and hospital lengths of stay, along with postoperative morbidities, were similar between the two groups. Operative mortality was 2% in the TECAB and 0% in the RA-MIDCAB group (P = NS). Total hospital cost was significantly higher with TECAB compared with RA-MIDCAB (US $33,769 vs. $22,679, P < 0.001), which was primarily driven by operative costs (US $17,616 vs. $26,803, P < 0.001).

CONCLUSIONS: Totally endoscopic coronary artery bypass and RA-MIDCAB both demonstrated excellent short-term clinical outcomes. However, TECAB was associated with significantly higher hospital costs. Further comparisons, including long-term outcomes, patient satisfaction, and functional status, are needed to evaluate whether this additional cost is justified.

Clinical Institute

Cardiovascular (Heart)

Department

Cardiology

Department

Surgery

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