title: Left anterior small thoracotomy versus coronary artery bypass graft for single-vessel occlusion. A cost identification analysis.
abstract: OBJECTIVE
  Single-vessel bypass can often be accomplished through less invasive techniques than conventional coronary artery bypass graft (CABG) at substantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thoracotomy (LAST).
  
  
  METHODS
  Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. The study groups consisted of 50 patients who underwent LAST and 28 who underwent single-vessel conventional CABG during 1995 and 1996. A subsequent validation sample of 50 patients who underwent LAST was also analyzed. Hospitalization costs were estimated using a relative value unit methodology and were risk-adjusted for both perioperative risk factors and changes in operating room technology.
  
  
  RESULTS
  Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differences in surgical costs reflecting over 62% of this overall difference. Differences in average length of stay were under a half-day (10.0 for LAST vs. 10.46 for CABG). Only one inpatient fatality was reported; therefore, no inference regarding mortality differences could be made.
  
  
  CONCLUSIONS
  LAST is substantially less costly than conventional surgery, and the savings are potentially greater if hospital length of stay is reduced to a clinically recommended time of 2 days.
authors.affiliation: School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
authors.forename: E
authors.initials: E
authors.lastname: Nauenberg
authors.forename: J M
authors.initials: JM
authors.lastname: Dorn
authors.forename: T A
authors.initials: TA
authors.lastname: Salerno
authors.forename: J
authors.initials: J
authors.lastname: Bergsland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000191:economics; D003331:Coronary Vessels / Q000473:pathology*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D012189:Retrospective Studies; D013908:Thoracotomy / Q000191:economics / Q000379:methods*