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Minimally invasive, robotic mitral valve surgery provide comparable clinical benefits
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TORONTO — The clinical benefits of minimally invasive and robotic mitral valve surgery are comparable; however, the robotic procedure is associated with higher costs, according to a new report.
In recent years, minimally invasive mitral valve repair/replacement and robotic mitral valve repair/replacement have gained popularity. However, the evidence base was lacking a direct cost-benefit comparison of minimally invasive vs. robotic mitral valve surgery.
To fill this gap, Mohammed Hassan, MD, from the division of cardiothoracic surgery at University of New Mexico Health Sciences Center, and colleagues conducted a literature review of 21 studies to compare outcomes of the surgical techniques, and three studies and institution experience to compare costs.
Mohammed Hassan
Photo by Rebecca Gustaf
“The argument has been that the robotic approach is more expensive, but that the additional cost is offset by benefits such as a decrease in the rate of blood transfusions and allowing patients to be discharged earlier,” Hassan told Cardiology Today. “But, even after achieving economies of scale, if you have a large volume [of robotic surgeries], it is still significantly more expensive than the minimally invasive approach."
On average, the total cost per case for robotic mitral valve repair/replacement was $3,911 more ($259 per case) than minimally invasive mitral valve repair/replacement, assuming an institutional volume of 50 cases per year. Under the assumption of an institutional volume of 100 cases per year, the excess cost of robotic surgery was $2,985 ($169 per case) over minimally invasive surgery.
At 30 days, the mortality rate was 1.24% with minimally invasive surgery vs. 0.55% for robotic surgery (OR=2.27; P=.052).
The researchers observed a significant difference in the conversion rate to conventional mitral valve surgery: 0.77% with minimally invasive surgery vs. 1.83% with robotic surgery (OR=0.32; P<.001).
In other results, postoperative atrial fibrillation was significantly more common among patients who underwent robotic surgery (19.67% vs. 11.42%; OR=0.53; P<.001). The rate of neurologic events was also higher with robotic surgery (2.37% vs. 1.32%; OR=0.55; P<.02). Mean time of cardiopulmonary bypass was longer among patients who underwent minimally invasive surgery (137.4 minutes vs. 130.4 minutes), but cross-clamp time was shorter (82.2 minutes vs. 96.7 minutes).
Minimally invasive surgery was associated with a longer length of hospital stay (7.78 days vs. 5.54 days), which resulted in higher length of stay-related costs for minimally invasive surgery compared with robotic surgery ($862 per case). The researchers attributed the difference in length of stay to one study included in the review that demonstrated a considerably extended length of hospital study for minimally invasive surgery (mean, 12.4 days).
“We believe that benefits are comparable for both approaches, but the costs are significantly different, with the costs being significantly lower for the minimally invasive approach,” Hassan said.
He noted that there is a learning curve associated with minimally invasive surgery, and an even steeper learning curve with the robotic approach. – by Louise Gagnon
For more information:
Hassan M. Abstract #81. Presented at: American Association for Thoracic Surgery Annual Meeting; April 26-30, 2014; Toronto.
Disclosure: Hassan reports no relevant financial disclosures.