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Left anterior small thoracotomy versus coronary artery bypass graft for single-vessel occlusion. A cost
E Nauenberg1, J M Dorn, T A Salerno
1School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
Insights
Left anterior small thoracotomy (LAST) is a less invasive and more cost-effective alternative to conventional coronary artery bypass graft (CABG) surgery. This study found LAST significantly reduced hospitalization costs compared to CABG.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Health Economics
Background:
- Conventional coronary artery bypass graft (CABG) surgery can be invasive and costly.
- Less invasive techniques for single-vessel bypass offer potential cost savings.
Purpose of the Study:
- To empirically determine the cost savings associated with left anterior small thoracotomy (LAST).
- To compare hospitalization costs of LAST versus conventional CABG for single-vessel bypass.
Main Methods:
- Retrospective review of medical and billing records for 50 LAST patients and 28 CABG patients (1995-1996).
- Risk-adjusted hospitalization costs using relative value unit methodology.
- Analysis of a subsequent validation sample of 50 LAST patients.
Main Results:
- Risk-adjusted hospitalization costs for LAST were $9,510 versus $12,546 for CABG (p < .01).
- Surgical costs accounted for over 62% of the overall cost difference.
- Average length of stay showed minimal difference (10.0 days for LAST vs. 10.46 days for CABG).
Conclusions:
- Left anterior small thoracotomy (LAST) is substantially less costly than conventional CABG.
- Potential for greater cost savings exists if hospital length of stay for LAST is reduced.
Objectives:
Single-vessel bypass can often be accomplished through less invasive techniques than conventional coronary artery bypass graft (CABG) at substantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thoracotomy (LAST).
Methods:
Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. The study groups consisted of 50 patients who underwent LAST and 28 who underwent single-vessel conventional CABG during 1995 and 1996. A subsequent validation sample of 50 patients who underwent LAST was also analyzed. Hospitalization costs were estimated using a relative value unit methodology and were risk-adjusted for both perioperative risk factors and changes in operating room technology.
Results:
Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differences in surgical costs reflecting over 62% of this overall difference. Differences in average length of stay were under a half-day (10.0 for LAST vs. 10.46 for CABG). Only one inpatient fatality was reported; therefore, no inference regarding mortality differences could be made.
Conclusions:
LAST is substantially less costly than conventional surgery, and the savings are potentially greater if hospital length of stay is reduced to a clinically recommended time of 2 days.
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