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Comparison of Index Hospitalization Costs Between Robotic CABG and Conventional CABG: Implications for Hybrid
Galina Leyvi1, Clyde B Schechter2, Sankalp Sehgal1
1Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY.
Insights
Robotic coronary artery bypass grafting (CABG) offers clinical benefits like shorter stays and fewer complications compared to conventional CABG. However, robotic CABG does not significantly increase hospitalization costs, except when hybrid revascularization is performed concurrently.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Health Economics
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for treating coronary artery disease.
- Robotic-assisted surgery offers potential advantages in precision and recovery.
- Comparative cost-effectiveness of robotic versus conventional CABG requires detailed analysis.
Purpose of the Study:
- To compare the direct costs of index hospitalization for robotic versus conventional CABG.
- To evaluate 30-day morbidity and mortality associated with both surgical approaches.
- To determine the cost implications of hybrid revascularization procedures.
Main Methods:
- Retrospective study utilizing propensity-matched pairs (1:1 nearest neighbor).
- Analysis of clinical and financial records from a single tertiary care university hospital.
- Inclusion of 2,088 consecutive primary CABG patients (2007-2012), with 141 matched pairs analyzed.
Main Results:
- Robotic CABG showed reduced operative time, lower blood transfusion rates, shorter overall and ICU length of stay, and fewer complications.
- No significant difference in index hospitalization costs between robotic and conventional CABG.
- Hybrid revascularizations performed during the same admission were significantly more costly for robotic procedures.
Conclusions:
- Robotically assisted CABG is clinically advantageous without increasing index hospitalization costs compared to conventional CABG.
- The cost-effectiveness is maintained unless hybrid procedures are combined in the same admission.
- Robotic CABG presents a viable alternative with comparable economic impact for standard procedures.
Objectives:
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.
