Cost Analysis of Robot-Assisted Versus On-Pump and Off-Pump Coronary Artery Bypass Grafting: A Single-Center Surgical and 30-Day Outcomes Comparison.

Monica Gianoli, Anne R de Jong, Pim van der Harst, Niels P van der Kaaij, Kirolos A Jacob, Willem J L Suyker
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Abstract

Objective: Throughout Europe, the interest in implementing robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) has been growing. However, concerns about additional costs have emerged concurrently. In this analysis, we aim to provide a comparison of the cumulative perioperative costs of RA-MIDCAB, on-pump coronary artery bypass grafting (CABG), and off-pump CABG (OPCAB).

Methods: We conducted a propensity score-matched analysis comparing patients undergoing RA-MIDCAB with those undergoing CABG or OPCAB at our institution from January 2016 to December 2021. After matching, we analyzed the combined intraoperative surgical costs and 30-day postoperative costs. We first compared RA-MIDCAB costs to CABG and then to OPCAB separately. Violin plots illustrated the cost distribution among individual patients. Total cost uncertainty was estimated using 1,000 bootstrapping iterations.

Results: Seventy-nine RA-MIDCAB patients were matched to 158 CABG patients, and 80 RA-MIDCAB patients were matched to 149 OPCAB patients. Considering both surgical and clinical outcomes, RA-MIDCAB yielded an average cost of €17,121 per patient (€16,781 to €33,294), CABG was €16,571 per patient (€16,664 to €41,860), and OPCAB was €15,463 per patient (€10,895 to €57,867). After bootstrap iterations, RA-MIDCAB was found to be €472 (2.8%) and €1,599 (10.3%) more expensive per patient than CABG and OPCAB, respectively.

Conclusions: In The Netherlands, the adoption of RA-MIDCAB did not show a significant economic impact on hospital resources. The additional robotic costs for the surgery were almost entirely offset by the cost savings during the postoperative hospital stay. However, these comparisons may differ when considering hybrid coronary revascularization with its additional percutaneous coronary intervention costs.

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机器人辅助冠状动脉旁路移植术与体外循环冠状动脉旁路移植术的成本分析:单中心手术与 30 天疗效比较。
目的:在整个欧洲,人们对实施机器人辅助微创冠状动脉直接搭桥术(RA-MIDCAB)的兴趣与日俱增。然而,与此同时也出现了对额外成本的担忧。在这项分析中,我们旨在比较 RA-MIDCAB、体外循环冠状动脉旁路移植术(CABG)和非体外循环冠状动脉旁路移植术(OPCAB)的累积围手术期成本:我们对 2016 年 1 月至 2021 年 12 月在本院接受 RA-MIDCAB 和接受 CABG 或 OPCAB 的患者进行了倾向评分匹配分析。匹配后,我们对术中手术费用和术后 30 天费用进行了综合分析。我们首先比较了 RA-MIDCAB 与 CABG 的成本,然后分别与 OPCAB 进行了比较。维奥拉图显示了单个患者的成本分布。总费用的不确定性是通过1000次引导迭代来估算的:结果:79 名 RA-MIDCAB 患者与 158 名 CABG 患者匹配,80 名 RA-MIDCAB 患者与 149 名 OPCAB 患者匹配。考虑到手术和临床结果,RA-MIDCAB每位患者的平均费用为17,121欧元(16,781欧元至33,294欧元),CABG每位患者的平均费用为16,571欧元(16,664欧元至41,860欧元),OPCAB每位患者的平均费用为15,463欧元(10,895欧元至57,867欧元)。经过自举迭代后,发现RA-MIDCAB比CABG和OPCAB每位患者的费用分别高出472欧元(2.8%)和1599欧元(10.3%):在荷兰,采用RA-MIDCAB对医院资源的经济影响不大。术后住院期间节省的费用几乎完全抵消了机器人手术的额外费用。不过,如果考虑到杂交冠状动脉血运重建术需要额外的经皮冠状动脉介入治疗费用,这些比较结果可能会有所不同。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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