Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques.
BACKGROUND
While potential benefits of robotic technology include decreased morbidity and improved recovery, some have suggested a prohibitively high cost. This study was undertaken to compare actual hospital costs of robotically assisted cardiac procedures with conventional techniques.


METHODS
We conducted a retrospective review of clinical and financial data of 20 patients who underwent atrial septal defect (ASD) closure and 20 patients who underwent mitral valve repair (MVr) using either robotic techniques or a conventional approach with a sternotomy. Total hospital cost (actual resource consumption) was subdivided into operative and postoperative costs.


RESULTS
Robotic technology did not significantly increase total hospital cost for ASD closure or MVr (p = 0.518 and p = 0.539). However, when including the initial capital investment for the robot through amortization of institutional costs, total hospital cost was increased by $3,773 for robotic ASD closure and $3,444 for robotic MVr (p = 0.021 and p = 0.004). The major driver of cost for robotic cases (operating room time) decreased over time.


CONCLUSIONS
Robotic technology did not significantly increase hospital cost. While the absolute cost for robotic surgery was higher than conventional techniques after taking into account the institutional cost of the robot, the major driver of cost for robotic procedures will likely continue to decrease, as the surgical team becomes increasingly familiar with robotic technology. Furthermore, other benefits, such as improvement in postoperative quality of life and more expeditious return to work may make a robotic approach cost-effective. Thus, it is possible that the benefits of robotic surgery may justify investment in this technology.
Morgan
Jeffrey A
JA
Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. Jeffrey.Morgan@mssm.edu
Thornton
Barbara A
BA
Peacock
Joy C
JC
Hollingsworth
Karen W
KW
Smith
Craig R
CR
Oz
Mehmet C
MC
Argenziano
Michael
M
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods; D016009:Chi-Square Distribution; D017046:Cost Savings; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000191:economics*; D016896:Treatment Outcome; D014481:United States