Cardiothoracic Surgery, Department of Heart and Lungs, University Medical Center Utrecht, The Netherlands.
Cardiology, Department of Heart and Lungs, University Medical Center Utrecht, The Netherlands.
Innovations (Phila). 2024 Jul-Aug;19(4):416-424. doi: 10.1177/15569845241269312. Epub 2024 Sep 12.
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).
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.
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.
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.
在整个欧洲，对实施机器人辅助微创直接冠状动脉旁路移植术（RA-MIDCAB）的兴趣日益增长。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。
我们进行了一项倾向评分匹配分析，比较了 2016 年 1 月至 2021 年 12 月在我们机构接受 RA-MIDCAB 的患者与接受 CABG 或 OPCAB 的患者。匹配后，我们分析了联合术中手术成本和 30 天术后成本。我们首先将 RA-MIDCAB 成本与 CABG 进行比较，然后分别与 OPCAB 进行比较。小提琴图说明了个体患者的成本分布。使用 1000 次引导迭代来估计总费用不确定性。
79 例 RA-MIDCAB 患者与 158 例 CABG 患者匹配，80 例 RA-MIDCAB 患者与 149 例 OPCAB 患者匹配。考虑到手术和临床结果，RA-MIDCAB 的每位患者平均成本为 17121 欧元（16781 至 33294 欧元），CABG 为 16571 欧元（16664 至 41860 欧元），OPCAB 为 15463 欧元（10895 至 57867 欧元）。经过引导迭代，发现 RA-MIDCAB 比 CABG 和 OPCAB 分别每例患者多花费 472 欧元（2.8%）和 1599 欧元（10.3%）。
在荷兰，采用 RA-MIDCAB 对医院资源没有产生显著的经济影响。手术的额外机器人成本几乎完全被术后住院期间的成本节约所抵消。然而，当考虑到具有额外经皮冠状动脉介入治疗成本的杂交冠状动脉血运重建时，这些比较可能会有所不同。
