Topic: H. Quality of Life Outcomes Analysis (clinical and/or financial)
Superior Financial and Quality Metrics with Robotically-assisted (DaVinci) Coronary Artery Revascularization
Robert S Poston, Jr., Bartley Griffith, Stephen T Bartlett
University of Maryland, Baltimore, MD
OBJECTIVE(S): Payers are considering linking reimbursement for coronary artery bypass surgery (CABG) to “performance” according to patient outcome metrics. Minimally invasive CABG (mini-CABG) decreases in-hospital morbidity. The purpose of this study was to investigate its effect on metrics that influence quality of life after hospital discharge.
METHODS: 100 consecutive miniCABG cases performed using IMA grafting ± coronary stenting were compared to a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.6 vs. 2.7), off-pump. We compared perioperative costs, time to return to work/normal activity and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1yr: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1yr), stroke or death.
RESULTS: For MiniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (3.8±3.9 vs. 22.5±19.3hr), hospital stay (3.6±1.5 vs. 6.5±2.1day) and transfusion (0.3±0.5 vs. 1.5±1.3U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t=-2.15,P=0.04), while sternotomy CABG increased MACCE (figure), partly from lower target-vessel patency (p=0.09).
CONCLUSIONS: MiniCABG shortens patient recovery time and minimizes MACCE risk at 1yr vs. sternotomy CABG. This finding occurred without increasing costs and with superior target vessel graft patency. MIniCABG has superior quality and outcome metrics vs. standard-of-care CABG.