25 Jun Robotic-Assisted Cardiac Surgery: Higher Cost But Shorter Hospital Stay
MedicalResearch.com Interview with:
Vanita Ahuja, MD, MPH
Department of General Surgery
York Hospital, York, Pennsylvania
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Ahuja: Robotic-assisted surgery has been slowly accepted within the medical community. Felger et al. (1999), Falk et al. (2000), and Loumet et al. (2000) state that specific to cardiac surgery, the advantages of the robot in coronary artery bypass grafting (CABG) and valvular operations were demonstrated with increased visualization, ease of harvest, and quality of vascular anastomoses as early as 1999. However, Giulianotti, et al. (2003), Morgan et al. (2005), and Barbash et al. (2010) suggest that although safety and efficacy are supported, it is not conclusive yet that robot-assisted surgery is cost-effective, given the high cost of the robot itself, longer operating times, and the short life of the robotic instruments. The purpose of our paper was to compare outcomes of complications, length of stay (LOS), actual cost, and mortality between non-robotic and robotic-assisted cardiac surgery.
In general surgery and subspecialties, the use of the robot has increased significantly over the past few years. It has been noted that robotic surgery improves on laparoscopic surgery by providing increased intra-cavity articulation, increased degrees of freedom, and downscaling of motion amplitude that may reduce the strain on the surgeon.
The biggest growth in robotic surgery has been seen in the fields of gynecology and urology. Recently, Wright et al. reported an increase in robotic assisted hysterectomy from 0.5 percent of the procedures in 2007 compared to 9.5 percent in 2010 for benign disease. In their study, robotic assisted surgery had similar outcomes to laparoscopic surgery but higher total cost of $2,189 more per case. In urologic surgery, Leddy et al. reported in 2010 that radical prostatectomy remains the biggest utilization of robotic assisted surgery in urology with 1% in 2001 to 40% of all cases in 2006 performed in the United States.
Utilizing a nationwide database from 2008-2011, subjects were propensity matched by 14 patient characteristics to reduce selection bias in a retrospective study. The patients were then divided into three groups by operation types: valves, vessels and other type. Univariate analysis revealed that robotic-assisted surgery, compared to non-robotic surgery, had higher cost ($39,030 vs. $36,340), but lower LOS (5 vs. 6 days) and mortality (1% vs. 1.9%, all p<0.001). For those who had one or more complications, robotic-assisted cardiac surgery had fewer complications (27.2%) to non-robotic cardiac surgery (30.3%, p < .001).
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Ahuja: Robotic-assisted cardiac surgery increased by 600% from 0.06% to .4% over four year period. Robotic-assisted cardiac surgery appears to have reduced mortality and complications compared to similar matched characteristics non-robotic surgery patients, helping to offset upfront costs. Robotic-assisted cardiac surgery has lower length of stay than non-robotic surgery. Results of this study suggest robotic-assisted cardiac surgery may be as safe as non-robotic surgery and offer the surgeon an additional technique for performing cardiac surgery.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Ahuja: Further studies need to be done to show long-term benefits including quality of life and pain scores. Further research may also consider the use of The Society of Thoracic Surgeons (STS) database which allows 30 day follow-up post-operative, has further information on patient’s other co-morbidities and surgeon training.
Citation:
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Vanita Ahuja, MD, MPH, Department of General Surgery, & York Hospital, York, Pennsylvania (2015). Robotic-Assisted Cardiac Surgery: Higher Cost But Shorter Hospital Stay
Last Updated on June 25, 2015 by Marie Benz MD FAAD