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

Leyvi, Galina; Schechter, Clyde B.; Sehgal, Sankalp; Greenberg, Mark A.; Snyder, Max; Forest, S.; Mais, Alec; Wang, Nan; DeLeo, Patrice; DeRose, Joseph J.

doi:10.1053/j.jvca.2015.07.031

Cited by 27 publications

(40 citation statements)

References 25 publications

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“…Such a result is likely because of the small size, and, therefore, limited power, of our cohort, but an overall investigation of cost savings or inflation in MICABG procedures have presented mixed results with dependence on surgical technique. In a series by Leyvi et al utilizing STS data looking at robotic LIMA‐LAD CABG, whereas operative time, transfusion requirements, LOS, and composite complication rate were significantly less compared with conventional CABG, robotic‐assistance to facilitate a minimally‐invasive approach only offered a cost‐benefit in a hybrid revascularization setting. Pasrija et al retrospectively reviewed STS data for 50 robotic‐assisted MICABG and 50 totally‐endoscopic CABG (TECAB) with robotic distal anastomosis procedures for single‐vessel LIMA‐LAD revascularizations and demonstrated higher total hospital costs with TECAB (US $33 769 vs $22 679, P < .001), which was primarily because of higher operative costs (US $26 803 vs $17 616, P < .001).…”

Section: Resultsmentioning

confidence: 45%

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

et al. 2019

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Background: Coronary artery bypass grafting (CABG) can be performed through a variety of approaches. Minimally‐invasive CABG (MICABG) may reduce perioperative morbidity. Previous results demonstrate improved perioperative outcomes; however, adoption has been limited. Methods: The Society of Thoracic Surgeons (STS) database and electronic medical record at a single institution were reviewed for isolated left internal mammary to left anterior descending artery (LIMA‐LAD) bypass procedures performed between 2011 and 2018. Patients were grouped on the basis of operative approach, comparing sternotomy to non‐sternotomy (minimally‐invasive). Patient characteristics, perioperative variables, and short‐ and long‐term outcomes were compared. Primary outcomes included mortality and major adverse cardiac events (MACE). Secondary outcomes were morbidity. Results: A total of 42 MICABG and 54 conventional LIMA‐LAD procedures were performed with 95.2% of MICABG procedures performed by two surgeons. MICABG were more often elective (83.3 vs 38.9%, P < .001). STS risk scores predicted equitable mortality and morbidity for MICABG dependent on operative indication. MICABG was associated with fewer pulmonary complications (0.0 vs 11.1%, P = .033), in‐hospital events (11.9 vs 37.0%, P = .005), and shorter intensive care unit (34.1 vs 66.0 hours, P = .022) and total length of stay (3.7 vs 6.5 days, P = .002). There were no observed strokes, myocardial infarctions, or reoperations. MICABG patients demonstrated reduced thirty‐day mortality (0.0 vs 10.9%, P = .036) and improved Kaplan‐Meier 5‐year (95.2 vs 77.9%, P = .016) and MACE‐free survival (89.2 vs 63.9%, P = .010). Conclusions: Minimally‐invasive LIMA‐LAD CABG demonstrates improved early postoperative morbidity and a long‐term mortality benefit. In select patients, minimally‐invasive approaches to single‐vessel grafting may be beneficial when performed by experienced surgeons in the elective setting.

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Section: Resultsmentioning

confidence: 45%

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

et al. 2019

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“…13 A search of the literature for the direct costs associated with robotic versus conventional CABG reveals a single article by Leyvi and colleagues. 27 This retrospective propensity-matched study followed 2088 consecutive patients who underwent CABG at a single academic tertiary care centre to compare the direct costs of the index hospitalization and 30-day morbidity and mortality incurred during robotic and conventional CABG. The findings suggest that despite being associated with a shorter surgery, shorter length of stay and a lower complication rate, the cost of the robotic CABG procedure did not significantly differ from that of conventional cases Given documented evidence of a significant treatment effect on the patient-important outcome by Ezelsoy and colleagues, 11,12 which corresponds to the results of Raad and colleagues, 13 and additional patient-important measures that demonstrate similar or improved clinical outcomes and associated costs, one can conclude that the benefits of the proposed intervention likely outweigh the associated risks.…”

Section: Are the Results Applicable To My Patients?mentioning

confidence: 99%

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Gallo

Eskicioglu

Braga

et al. 2017

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Phase 3 randomized controlled trials are the widely accepted gold standard through which treatment decisions are made, as they assess the efficacy of a novel treatment against the control on the relevant patient population. The effectiveness of the novel treatment should be derived by measuring patientimportant outcomes; however, to accurately assess these outcomes, clinical trials often require extensive patient follow-up and large sample sizes that can incur substantial expense. For this reason, investigators substitute surrogate end points to reduce the sample size and duration of a trial, ultimately reducing cost. The purpose of this article is to help surgeons appraise the surgical literature that use surrogate end points for patient-important outcomes. Summary DISCUSSIONS IN SURGERY

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“…We have performed robotic beating‐heart TECAB, which has advantages of both off‐pump and sternal‐sparing, since 2013 at our current institution using anastomotic connectors and the EndoWrist stabilizer. The rate of BT in this series was 17%, which is comparable to other reports of minimally invasive CABG procedures . We consider this to be relatively low despite the fact that we have not traditionally had a strict transfusion policy (in non‐Jehovah's Witness patients), and multiple members of the postoperative care team have been able to order BTs.…”

Section: Discussionmentioning

confidence: 99%

“…Given the fact that the avoidance of BT could provide positive effects on clinical outcomes, alternative approaches to coronary bypass procedures have been utilized to decrease the rate of BT, such as off‐pump CABG, sternal‐sparing minimally invasive direct coronary artery bypass (MIDCAB), or hybrid coronary revascularization . Recently, robotic totally endoscopic or robotic‐assisted coronary artery bypass surgery has evolved as the least invasive option for coronary revascularization with lower BT rates compared with the conventional CABG . We have performed robotic beating‐heart totally endoscopic coronary artery bypass (TECAB) using distal anastomotic connectors at our current institution since 2013.…”

Section: Introductionmentioning

confidence: 99%

“…4 Recently, robotic totally endoscopic or robotic-assisted coronary artery bypass surgery has evolved as the least invasive option for coronary revascularization with lower BT rates compared with the conventional CABG. 5 We have performed robotic beatingheart totally endoscopic coronary artery bypass (TECAB) using distal anastomotic connectors at our current institution since 2013.…”

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confidence: 99%

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Predictors of blood transfusion use in robotic beating‐heart totally endoscopic coronary artery bypass with anastomotic connectors

et al. 2019

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Background We sought to identify the independent predictors of blood transfusion requirement in robotic beating‐heart patients with totally endoscopic coronary artery bypass (TECAB). Methods We retrospectively reviewed patients undergoing TECAB with distal anastomotic connectors from July 2013 to May 2017 at our institution. The cohorts were divided into patients who received a blood transfusion (BT group) and patients who did not (non‐blood transfusion [NBT] group). Results Two‐hundred seventy‐four consecutive patients underwent TECAB, and 47 patients (17%; BT group) received BT. The BT group had a lower preoperative hemoglobin level and a higher rate of preoperative risk profiles and higher society of thoracic surgeons (STS) predicted the risk of mortality. Kaplan Meier analysis showed decreased 1‐year survival in the BT group compared with the NBT group (90.9% vs 96.4%; logrank, 0.017). The Youden index identified a preoperative hemoglobin cutoff value of 12.2 g/dL (sensitivity 60.9%, specificity 79.3%) and operative time of 300 minutes (sensitivity 61.7%, specificity 59.0%) for BT requirement. Multivariate logistic regression analysis identified a preoperative hemoglobin <12.2 g/dL (odds ratio, 6.03; 95% confidence interval, 3.01‐12.1) and an operative time >300 minutes (odds ratio, 2.15; 95% confidence interval, 1.07‐4.33) as independent factors associated with BT requirement. Conclusions We found that preoperative hemoglobin and operative time were independent predictors of BT requirement during robotic beating‐heart TECAB. These data would help to select patients to minimize perioperative BT as well as predict outcomes after this procedure.

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

Cited by 27 publications

References 25 publications

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Predictors of blood transfusion use in robotic beating‐heart totally endoscopic coronary artery bypass with anastomotic connectors

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