title: Comparison of Index Hospitalization Costs Between Robotic CABG and Conventional CABG: Implications for Hybrid Coronary Revascularization.
abstract: OBJECTIVE
  To compare the direct costs of the index hospitalization and 30-day morbidity and mortality incurred during robotic and conventional coronary artery bypass grafting at a single institution based on hospital clinical and financial records.
  
  
  METHODS
  Retrospective study, propensity-matched groups with one-to-one nearest neighbor matching.
  
  
  METHODS
  University hospital, a tertiary care center.
  
  
  METHODS
  Two thousand eighty-eight consecutive patients who underwent primary coronary artery bypass grafting (CABG) from January 2007 to March 2012.
  
  
  METHODS
  One hundred forty-one matched pairs were created and analyzed.
  
  
  RESULTS
  Robotic CABG was associated with a decrease in operative time (5.61±1.1 v 6.6±1.15 hours, p<0.001), a lower need for blood transfusion (12.8% v 22.6%, p = 0.04), a shorter length of stay (6 [4-9]) v 7 [5-11] days, p = 0.001), a shorter ICU stay (31 [24-49] hours v 52 [32-96.5] hours, p<0.001) and lower NY state complications composite rate (4.26% v 13.48%, p = 0.01). In spite of that, the cost of robotic procedures was not significantly different from matched conventional cases ($18,717.35 [11,316.1-34,550.6] versus $18,601 [13,137-50,194.75], p = 0.13), except 26 hybrid coronary revascularizations in which angioplasty was performed on the same admission (hybrid 25,311.1 [18,537.1-41,167.85] versus conventional 18,966.13 [13,337.75-56,021.75], p = 0.02).
  
  
  CONCLUSIONS
  Robotically assisted CABG does not increase the cost of the index hospitalization when compared to conventional CABG unless hybrid revascularization is performed on the same admission.
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY. Electronic address: gleyvi@montefiore.org.
authors.forename: Galina
authors.initials: G
authors.lastname: Leyvi
authors.affiliation: Department of Family and Social Medicine, Bronx, NY.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Sehgal
authors.affiliation: Department of Medicine, Division of Cardiology, Bronx, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenberg
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY.
authors.forename: Max
authors.initials: M
authors.lastname: Snyder
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY.
authors.forename: Stephen
authors.initials: S
authors.lastname: Forest
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY.
authors.forename: Alec
authors.initials: A
authors.lastname: Mais
authors.affiliation: Medical Student, Bronx, NY.
authors.forename: Nan
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY.
authors.forename: Patrice
authors.initials: P
authors.lastname: DeLeo
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DeRose
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000191:economics* / Q000639:trends; D003324:Coronary Artery Disease / Q000191:economics* / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000639:trends; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000191:economics / Q000639:trends; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000639:trends
keywords: CABG; PCI; coronary stent; healthcare costs; minimally invasive surgery; robotic surgery