Improving affordability through innovation in the surgical treatment of mitral valve disease.
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.


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).


CONCLUSIONS
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.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. Electronic address: suri.rakesh@mayo.edu.
Rakesh M
RM
Suri
Jeffrey E
JE
Thompson
Harold M
HM
Burkhart
Marianne
M
Huebner
Bijan J
BJ
Borah
Zhuo
Z
Li
Hector I
HI
Michelena
Sue L
SL
Visscher
Veronique L
VL
Roger
Richard C
RC
Daly
David J
DJ
Cook
Maurice
M
Enriquez-Sarano
Hartzell V
HV
Schaff
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods / Q000639:trends; D003363:Cost Control / Q000379:methods; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000191:economics* / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000191:economics* / Q000601:surgery; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D057216:Propensity Score; D011446:Prospective Studies; D012371:Robotics / Q000191:economics* / Q000379:methods; D014481:United States
ICU; LOS; MR; PCU; intensive care unit; length of stay; mitral regurgitation; progressive care unit