Document Detail

Improving affordability through innovation in the surgical treatment of mitral valve disease.
MedLine Citation:
PMID:  24079678     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses.
PATIENTS AND METHODS: We studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation. Generalized linear mixed models were used to estimate the effect of the type of surgery on cost while adjusting for a time effect.
RESULTS: Baseline characteristics of the study patients were similar, and all patients underwent successful mitral valve repair with no early deaths. Median length of stay (LOS) for patients undergoing open repair was unchanged at 5.3 days (P=.636) before and after systems innovation implementation, and was lower for robotic patients at 3.5 and 3.4 days, respectively (P=.003), throughout the study. The overall median costs associated with open and robotic repair were $31,838 and $32,144, respectively (P=.32). During the preimplementation period, the total cost was higher for robotic ($34,920) than for open ($32,650) repair (P<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001).
CONCLUSION: Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.
Rakesh M Suri; Jeffrey E Thompson; Harold M Burkhart; Marianne Huebner; Bijan J Borah; Zhuo Li; Hector I Michelena; Sue L Visscher; Veronique L Roger; Richard C Daly; David J Cook; Maurice Enriquez-Sarano; Hartzell V Schaff
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  88     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-01     Completed Date:  2013-12-11     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  1075-84     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cardiac Surgical Procedures / economics,  methods,  trends
Cost Control / methods
Hospital Costs / trends*,  utilization*
Mitral Valve Insufficiency / economics*,  surgery
Mitral Valve Prolapse / economics*,  surgery
Multivariate Analysis
Outcome and Process Assessment (Health Care)
Propensity Score
Prospective Studies
Robotics / economics*,  methods
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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