Comparison of Index Hospitalization Costs Between Robotic CABG and Conventional CABG: Implications for Hybrid Coronary Revascularization

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• 作者：Galina Leyvi ; MD ; MS^* ; ^{gleyvi@montefiore.org" class="auth_mail" title="E-mail the corresponding author} ; Clyde B. Schechter ; MA ; MD^&dagger ; ; Sankalp Sehgal ; MD^* ; Mark A. Greenberg ; MD^&Dagger ; ; Max Snyder ; MD^* ; Stephen Forest ; MD^§ ; ; Alec Mais^* ; Nan Wang ; MD^‖ ; Patrice DeLeo ; MBA^§ ; ; Joseph J. DeRose Jr. ; MD^§ ;
• 关键词：minimally invasive surgery ; coronary stent ; PCI ; CABG ; healthcare costs ; robotic surgery
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：1
• 页码：12-18
• 全文大小：141 K

文摘

To compare the direct costs of the index hospitalization and 30-day morbidity and mortality incurred during robotic and conventional coronary artery bypass grafting at a single institution based on hospital clinical and financial records.

Design

Retrospective study, propensity-matched groups with one-to-one nearest neighbor matching.

Setting

University hospital, a tertiary care center.

Participants

Two thousand eighty-eight consecutive patients who underwent primary coronary artery bypass grafting (CABG) from January 2007 to March 2012.

Interventions

One hundred forty-one matched pairs were created and analyzed.

Measurements and Main Results

Robotic CABG was associated with a decrease in operative time (5.61±1.1 v 6.6±1.15 hours, p<0.001), a lower need for blood transfusion (12.8% v 22.6%, p = 0.04), a shorter length of stay (6 [4-9]) v 7 [5-11] days, p = 0.001), a shorter ICU stay (31 [24-49] hours v 52 [32-96.5] hours, p<0.001) and lower NY state complications composite rate (4.26% v 13.48%, p = 0.01). In spite of that, the cost of robotic procedures was not significantly different from matched conventional cases ($18,717.35 [11,316.1-34,550.6] versus $18,601 [13,137-50,194.75], p = 0.13), except 26 hybrid coronary revascularizations in which angioplasty was performed on the same admission (hybrid 25,311.1 [18,537.1-41,167.85] versus conventional 18,966.13 [13,337.75-56,021.75], p = 0.02).

Conclusion

Robotically assisted CABG does not increase the cost of the index hospitalization when compared to conventional CABG unless hybrid revascularization is performed on the same admission.