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Robotic mitral valve operations by experienced surgeons are cost-neutral and durable at 1 year
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 156:1040-1047
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Robotic mitral valve surgery has potential advantages in patient satisfaction and 30-day outcome. Cost concerns and repair durability limit wider adoption of robotic technology. This study examined detailed cost differences between robotic and sternotomy techniques in relation to outcomes and durability following robotic mitral program initiation. Methods Between April 2013 and October 2015, 30-day and 1-year outcomes of 328 consecutive patients undergoing robotic or sternotomy mitral valve repair or replacement by experienced surgeons were examined. Multivariable logistic regression informed propensity matching to derive a cohort of 182 patients. Echocardiographic follow-up was completed at 1 year in all robotic patients. Detailed activity-based cost accounting was applied to include direct, semidirect, and indirect costs with special respect to robotic depreciation, maintenance, and supplies. A quantitative analysis of all hospital costs was applied directly to each patient encounter for comparative financial analyses. Results Mean predicted risk of mortality was similar in both the robotic (n = 91) and sternotomy (n = 91) groups (0.9% vs 0.8%; P > .431). The total costs of robotic mitral operations were similar to those of sternotomy ($27,662 vs $28,241; P = .273). Early direct costs were higher in the robotic group. There was a marked increase in late indirect cost with the sternotomy cohort related to increased length of stay, transfusion requirements, and readmission rates. Robotic repair technique was associated with no echocardiographic recurrence greater than trace to only mild regurgitation at 1 year. Conclusions Experienced mitral surgeons can initiate a robotic program in a cost-neutral manner that maintains clinical outcome integrity as well as repair durability.
- Subjects :
- Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Mitral Valve Annuloplasty
Cost-Benefit Analysis
medicine.medical_treatment
Prom
030204 cardiovascular system & hematology
03 medical and health sciences
Indirect costs
0302 clinical medicine
Robotic Surgical Procedures
Mitral valve
medicine
Risk of mortality
Humans
Hospital Costs
Propensity Score
Aged
Retrospective Studies
Aged, 80 and over
Heart Valve Prosthesis Implantation
Mitral regurgitation
Mitral valve repair
business.industry
technology, industry, and agriculture
Mitral Valve Insufficiency
Middle Aged
West Virginia
Sternotomy
Surgery
Logistic Models
Treatment Outcome
medicine.anatomical_structure
030228 respiratory system
Echocardiography
Propensity score matching
Cohort
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 156
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....10469d0f7e597cdf4148547bbed735c9