Robotic-assisted cardiac surgery produces better outcomes but higher costs

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Patients who underwent robotic-assisted cardiac surgery had significant reductions in length of hospital stay, complications and mortality compared with patients who received nonrobotic surgery. However, robotic-assisted cardiac surgery cost significantly more than nonrobotic options.

Franz Yanagawa, MD, of York Hospital in York, Pennsylvania, and colleagues published their findings online in JAMA Surgery on June 17.

During the past few years, robotic-assisted surgery has become more popular, particularly in gynecology and urology. In cardiology procedures, robots are most commonly used in CABG and in valvular operations.

The researchers analyzed more than 1.3 million cardiac cases from Jan. 1, 2008 to Dec. 31, 2011. They obtained the data from the Agency for Healthcare Research and Quality ‘s Nationwide Inpatient Sample, which Yanagawa et al wrote is the largest source of hospital discharge information in the U.S.

Of the cases, 99.6 percent were nonrobotic-assisted and 0.4 percent were robotic-assisted. Still, during the study, the use of robotic-assisted surgery increased by 600 percent, from 0.057 percent of all cases in 2008 to 0.390 percent of all cases in 2011. Of the patients undergoing robotic-assisted procedures, 68.9 percent were male, 83.7 percent were white and 76.2 percent elected to have the surgery.

After propensity score matching, the researchers analyzed 10,331 nonrobotic-assisted cases and 5,199 robotic-assisted cases. Of the procedures, 42.6 percent involved the vessels, 10.5 percent involved the valves or septa and 46.9 percent involved other heart and pericardium procedures.

The median cost was $39,030 for robotic-assisted procedures and $36,340 for robotic-assisted surgeries. The median length of stay was five days and six days, respectively. Patients in the robotic-assisted group also had a lower mortality rate (1 percent) compared with the nonrobotic-assisted group (1.9 percent).

Complications were found in 27.2 percent of patients in the robotic-assisted group and 30.3 percent of the nonrobotic-assisted group.

Yanagawa et al noted that there are concerns with the costs of robotic-assisted surgery, including a fixed cost of $1 million to $2.5 million per unit. They also mentioned surgeons need to perform 150 to 200 procedures before becoming comfortable with using the robot. Although robotic-assisted surgery cost $1,531 more than nonrobotic-assisted operations in this study, the researchers said the increased expense was offset by fewer complications and length of hospital stay.