Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
Ann Thorac Surg. 2021 May;111(5):1478-1484. doi: 10.1016/j.athoracsur.2020.06.136. Epub 2020 Sep 19.
Limited multi-institutional data evaluating minimally invasive cardiac surgery (MICS) coronary artery bypass surgery (CABG) outcomes have raised concern for increased resource utilization compared with standard sternotomy. The purpose of this study was to assess short-term outcomes and resource utilization with MICS CABG in a propensity-matched regional cohort.
Isolated CABG patients (2012-2019) were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by MICS CABG vs open CABG via sternotomy, propensity-score matched 1:2 to balance baseline differences, and compared by univariate analysis.
Of 26,255 isolated coronary artery bypass graft patients, 139 MICS CABG and 278 open CABG patients were well balanced after matching. There was no difference in the operative mortality rate (2.2% open vs 0.7% MICS CABG, P = .383) or major morbidity (7.9% open vs 7.2% MICS CABG, P = .795). However, open CABG patients received more blood products (22.2% vs 12.2%, P = .013), and had longer intensive care unit (45 vs 30 hours, P = .049) as well as hospital lengths of stay (7 vs 6 days, P = .005). Finally, median hospital cost was significantly higher in the open CABG group ($35,011 vs $27,906, P < .001) compared with MICS CABG.
Open CABG via sternotomy and MICS CABG approaches are associated with similar, excellent perioperative outcomes. However, MICS CABG was associated with fewer transfusions, shorter length of stay, and ∼$7000 lower hospital cost, a superior resource utilization profile that improves patient care and lowers cost.
与标准胸骨切开术相比，微创心脏手术（MICS）冠状动脉旁路移植术（CABG）的多机构数据有限，这引起了人们对资源利用增加的关注。本研究的目的是在一个倾向匹配的区域队列中评估 MICS CABG 的短期结果和资源利用情况。
从区域胸外科医师协会数据库中提取了 2012 年至 2019 年的单纯 CABG 患者。通过 MICS CABG 与胸骨切开术的开放 CABG 分层，通过倾向评分匹配 1:2 来平衡基线差异，并进行单变量分析。
在 26255 例单纯冠状动脉旁路移植术患者中，139 例 MICS CABG 和 278 例开放 CABG 患者匹配后情况良好。手术死亡率（2.2%开放与 0.7%MICS CABG，P=.383）或主要发病率（7.9%开放与 7.2%MICS CABG，P=.795）无差异。然而，开放 CABG 患者接受更多的血液制品（22.2%比 12.2%，P=.013），并且 ICU 时间更长（45 小时比 30 小时，P=.049）以及住院时间更长（7 天比 6 天，P=.005）。最后，开放 CABG 组的中位住院费用明显高于 MICS CABG 组（$35011 比 $27906，P<0.001）。
胸骨切开术和 MICS CABG 方法与类似的、极好的围手术期结果相关。然而，MICS CABG 与较少的输血、较短的住院时间和约$7000 更低的住院费用相关，其资源利用情况更好，改善了患者的护理并降低了成本。
