Minimally Invasive vs Open Coronary Surgery: A Multi-Institutional Analysis of Cost and Outcomes
| Autor: | Mohammed A. Quader, Eric J. Charles, J. Hunter Mehaffey, Robert B. Hawkins, Gorav Ailawadi, Alan M. Speir, Nicholas R. Teman |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Coronary surgery Coronary Artery Disease 030204 cardiovascular system & hematology law.invention 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine law Minimally invasive cardiac surgery Humans Minimally Invasive Surgical Procedures Medicine cardiovascular diseases Coronary Artery Bypass Aged Retrospective Studies Univariate analysis business.industry Perioperative Middle Aged Sternotomy Intensive care unit Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure 030228 respiratory system Cohort Costs and Cost Analysis Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The Annals of Thoracic Surgery. 111:1478-1484 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.06.136 |
| Popis: | Background Limited multi-institutional data evaluating minimally invasive cardiac surgery (MICS) coronary artery bypass surgery (CABG) outcomes have raised concern for increased resource utilization compared with standard sternotomy. The purpose of this study was to assess short-term outcomes and resource utilization with MICS CABG in a propensity-matched regional cohort. Methods Isolated CABG patients (2012-2019) were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by MICS CABG vs open CABG via sternotomy, propensity-score matched 1:2 to balance baseline differences, and compared by univariate analysis. Results Of 26,255 isolated coronary artery bypass graft patients, 139 MICS CABG and 278 open CABG patients were well balanced after matching. There was no difference in the operative mortality rate (2.2% open vs 0.7% MICS CABG, P = .383) or major morbidity (7.9% open vs 7.2% MICS CABG, P = .795). However, open CABG patients received more blood products (22.2% vs 12.2%, P = .013), and had longer intensive care unit (45 vs 30 hours, P = .049) as well as hospital lengths of stay (7 vs 6 days, P = .005). Finally, median hospital cost was significantly higher in the open CABG group ($35,011 vs $27,906, P Conclusions Open CABG via sternotomy and MICS CABG approaches are associated with similar, excellent perioperative outcomes. However, MICS CABG was associated with fewer transfusions, shorter length of stay, and ∼$7000 lower hospital cost, a superior resource utilization profile that improves patient care and lowers cost. |
| Databáze: | OpenAIRE |
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