Robotic-Assisted Versus Traditional Full-Sternotomy Coronary Artery Bypass Grafting Procedures: A Propensity-Matched Analysis of Hospital Costs

• Published in: The American journal of cardiology 2024-02, Vol.213, p.12-19
• Main Authors: Dokollari, Aleksander, Sicouri, Serge, Prendergrast, George, Ramlawi, Basel, Mahmud, Farah, Kjelstrom, Stephanie, Wertan, Maryann, Sutter, Francis
• Format: Article
• Language: English
• Subjects: Bypass; Cardiology; Cardiovascular disease; Cerebrovascular disease; Coronary artery; Coronary vessels; Cost analysis; Cost assessments; Costs; Creatinine; Diabetes; Grafting; Heart surgery; Hospital costs; Hospitals; Kidney diseases; Learning curves; Medical records; Morbidity; Mortality; Multivariate analysis; Ostomy; Patients; Radiology; Robotics; Stroke; Surgeons; Surgical equipment; Surgical implants; Vein & artery diseases
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2023.10.083

We aim to compare hospital costs of robotic-assisted coronary artery bypass grafting (CABG) versus conventional CABG. All consecutive 1,173 patients who underwent conventional and robotic-assisted CABG between January 2018 and June 2021 were included. After propensity-matching, 267 patients in each group (robotic-assisted vs conventional) were included in the study. Patient selection for each group was decided by a treating surgeon with a heart team based on clinical factors. Syntax score was not assessed. Total costs (direct + indirect hospital costs) of patients who underwent robotic-assisted and conventional CABG were compared. Direct cost expenses included surgical operating time, hospital stay, surgical implants and supplies, catheterization laboratory, pharmacy, radiology and ultrasound imaging, blood bank, cardiology, and so on. Indirect cost expenses included general administration medical records, and so on. Using the propensity-matched groups (n = 267), we summed the total cost by year. Results for 267 propensity-matched patients (each group) evidenced that total conventional CABG costs were $9.5 million (average of $35,580/patient), whereas robotic-assisted CABG costs were $5 million ($18,726/patient). Therefore, the differences between robotic-assisted and conventional CABG costs were $4.5 million ($16,853/patient), favoring robotic-assisted over conventional CABG. Differences in direct and indirect costs were $2.2 million and $1.8 million, respectively. When the cost of the Da Vinci robot was added ($1,200,000), the total cost was $3.3 million ($12,359 × patient) lower in the robotic-assisted CABG group. Multivariate analysis showed that, mainly, the shorter hospital length of stay (7 vs 5 days) accounts for the reduced costs observed in the robotic-assisted CABG group. In conclusion, in a mature practice, robotic-assisted CABG decreases hospital length of stay, leading to reduced hospital costs compared with conventional CABG.