October 03, 2013
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Hospital costs similar for robotic, open-chest mitral valve repair surgery

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Total hospital costs of mitral valve repair surgery were similar regardless of whether performed via a minimally invasive robotic procedure or conventional open-chest procedure, according to a new report from the Mayo Clinic.

The overall median cost was $32,144 for the robotic surgery and $31,838 for open-chest surgery (P=.32). Before systems innovation implementation in July 2009, the total cost of robotic surgery was higher than the total cost of open-chest surgery ($34,920 vs. $32,650; P<.001). After systems innovation implementation, median total cost was similar (robotic, $30,606; open chest, $31,310; P=.876).

Operating room costs were higher for robotic surgery before systems innovation implementation in 2009 ($12,691 vs. $8,474) and after implementation ($11,234 vs. $8,474; P<.001 for both). ICU and progressive care unit costs were lower for robotic surgery both before systems innovation implementation ($5,600 vs. $8,663) and after implementation ($4,595 vs. $8,663; P<.001 for both).

Rakesh A. Suri, MD, DPhil 

Rakesh M. Suri

Secondary outcomes of the study included total hospital length of stay and ICU length of stay. Patients who underwent robotic surgery (n=185) recovered faster and were discharged from the hospital earlier than patients who underwent open-chest surgery (n=185). Median length of hospital stay before systems innovation implementation was 3.5 days for robotic surgery cases and 5.3 for open-chest surgery cases and remained similar after implementation (P<.001 for both). Systems innovation implementation improved median length of ICU hospital stay. Median stay was 22.7 hours for robotic surgery cases and 24.6 hours for open-chest surgery cases before implementation (P=.006) and 9.3 hours and 24.3 hours after implementation, respectively (P<.001).

The study focused on propensity-matched patient pairs who underwent mitral valve repair surgery at Mayo Clinic in Rochester, Minn., between July 2007 and January 2011. The analysis covered two periods, before and after July 2009, when the clinic implemented a surgical process improvement redesign to make operating-room procedures and postoperative care more efficient.

“These data suggest that technical innovation within a milieu of systems improvement in cardiac surgical practice can be cost-neutral while improving affordability and contributing health care value,” Rakesh M. Suri, MD, DPhil, of the division of cardiovascular surgery at Mayo Clinic, and colleagues wrote.

Disclosure: Several researchers report financial ties to Abbott, Edwards Lifesciences, Sorin and St. Jude Medical.