Improving Affordability Through Innovation in the Surgical Treatment of Mitral Valve Disease

Abstract Objective To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses. Patients and Methods We studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation. Generalized linear mixed models were used to estimate the effect of the type of surgery on cost while adjusting for a time effect. Results Baseline characteristics of the study patients were similar, and all patients underwent successful mitral valve repair with no early deaths. Median length of stay (LOS) for patients undergoing open repair was unchanged at 5.3 days ( P =.636) before and after systems innovation implementation, and was lower for robotic patients at 3.5 and 3.4 days, respectively ( P =.003), throughout the study. The overall median costs associated with open and robotic repair were $31,838 and $32,144, respectively ( P =.32). During the preimplementation period, the total cost was higher for robotic ($34,920) than for open ($32,650) repair ( P