Robot-assisted mitral valve repair surgery was no more costly than open surgery, once a hospital initiated process improvements. What’s more, patients who underwent robotic surgery had a shorter length of stay, especially after innovations in the hospital’s systems were in place.
“In the current health care environment, health care institutions are increasingly expected to critically assess the economic value (outcomes divided by cost) of new treatments and technologies, particularly in potentially high-cost inpatient surgical subspecialties," wrote Rakesh M. Suri, MD, DPhil, of the Mayo Clinic in Rochester, Minn., in the October issue of Mayo Clinic Proceedings. Mitral valve repair using robotic surgery is less invasive than open surgery, and so it may lead to faster recuperation. But it also may require more use of resources, they recognized.
Suri et al looked at 185 propensity-matched pairs of patients who underwent either open or robot-assisted mitral valve repair surgery between July 1, 2007, and Dec. 31, 2010. They tapped the Olmsted County Healthcare Expenditure and Utilization Database to measure costs.
They wanted to evaluate not only technical innovation but also innovations in the clinic’s systems. In July of 2009, Mayo initiated a surgical process improvement initiative as well as a standardized postoperative care algorithm in the intensive care unit (ICU). Suri et al stratified surgical patients into pre- and post-implementation groups to compare costs and outcomes.
ICU length of stay was shorter in the robotic surgery group, both before and after implementation of the systems innovations, but the difference was more pronounced after implementation (changing from a mean 24.7 hours for the robotic surgery group vs. 26.7 hours for the open surgery group to 13.7 hours vs. 27.8 hours). The same pattern occurred for total hospital length of stay (changing from a mean four days vs. 5.6 days to 3.7 days vs. 5.7 days).
Median cost for the entire study period was higher for robot-assisted surgery, at $32,144 vs. $31,838 for open surgery. Pre-implementation median costs were $34,920 for robotic surgery vs. $32,650 for open surgery. Post-implementation costs were similar at $30,606 vs. $31,310.
Pre-implementation operating room costs were much higher for robotic surgery, at a median $12,691 vs. $8,474, but those costs also decreased post-implementation, to $11,234 vs. $8,474. ICU plus progressive care unit room and board costs didn’t change over time for open surgery, at a median $8,663. But they dropped from $5,600 to $4,595 for robotic surgery.
Costs associated with robotic surgery initially were higher but dropped with experience and with implementation of systems innovations, Suri and colleagues wrote. “Considering that the total hospital cost of robotic mitral valve repair is now similar to that of standard therapy and that robotic repair also expedites transition from the ICU and hospital discharge, an opportunity exists to improve value in surgical care delivery using technical (robotic) innovation.”
The finding that robotic mitral valve repair surgery is cost neutral should be reassuring to hospitals considering innovations, they wrote. But they added they selected low-risk patients for the study and that it was observational.