Improving affordability through innovation in the surgical treatment of mitral valve disease

Rakesh M. Suri, Jeffrey E. Thompson, Harold M. Burkhart, Marianne Huebner, Bijan J Borah, Zhuo Li, Hector I Michelena, Sue L. Visscher, Veronique Lee Roger, Richard C. Daly, David J. Cook, Maurice E Sarano, Hartzell V Schaff

Research output: Contribution to journalArticle

27 Citations (Scopus)

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<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001). Conclusion: Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.

Original languageEnglish (US)
Pages (from-to)1075-1084
Number of pages10
JournalMayo Clinic Proceedings
Volume88
Issue number10
DOIs
StatePublished - 2013

Fingerprint

Robotics
Mitral Valve
Costs and Cost Analysis
Therapeutics
Hospital Costs
Length of Stay
Ventilator Weaning
Intensive Care Units
Linear Models
Technology
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Improving affordability through innovation in the surgical treatment of mitral valve disease. / Suri, Rakesh M.; Thompson, Jeffrey E.; Burkhart, Harold M.; Huebner, Marianne; Borah, Bijan J; Li, Zhuo; Michelena, Hector I; Visscher, Sue L.; Roger, Veronique Lee; Daly, Richard C.; Cook, David J.; Sarano, Maurice E; Schaff, Hartzell V.

In: Mayo Clinic Proceedings, Vol. 88, No. 10, 2013, p. 1075-1084.

Research output: Contribution to journalArticle

Suri, Rakesh M. ; Thompson, Jeffrey E. ; Burkhart, Harold M. ; Huebner, Marianne ; Borah, Bijan J ; Li, Zhuo ; Michelena, Hector I ; Visscher, Sue L. ; Roger, Veronique Lee ; Daly, Richard C. ; Cook, David J. ; Sarano, Maurice E ; Schaff, Hartzell V. / Improving affordability through innovation in the surgical treatment of mitral valve disease. In: Mayo Clinic Proceedings. 2013 ; Vol. 88, No. 10. pp. 1075-1084.
@article{af4b97f3968b4bf89850f1dbdaa53128,
title = "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<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001). Conclusion: Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.",
author = "Suri, {Rakesh M.} and Thompson, {Jeffrey E.} and Burkhart, {Harold M.} and Marianne Huebner and Borah, {Bijan J} and Zhuo Li and Michelena, {Hector I} and Visscher, {Sue L.} and Roger, {Veronique Lee} and Daly, {Richard C.} and Cook, {David J.} and Sarano, {Maurice E} and Schaff, {Hartzell V}",
year = "2013",
doi = "10.1016/j.mayocp.2013.06.022",
language = "English (US)",
volume = "88",
pages = "1075--1084",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "10",

}

TY - JOUR

T1 - Improving affordability through innovation in the surgical treatment of mitral valve disease

AU - Suri, Rakesh M.

AU - Thompson, Jeffrey E.

AU - Burkhart, Harold M.

AU - Huebner, Marianne

AU - Borah, Bijan J

AU - Li, Zhuo

AU - Michelena, Hector I

AU - Visscher, Sue L.

AU - Roger, Veronique Lee

AU - Daly, Richard C.

AU - Cook, David J.

AU - Sarano, Maurice E

AU - Schaff, Hartzell V

PY - 2013

Y1 - 2013

N2 - 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<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001). Conclusion: Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.

AB - 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<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001). Conclusion: Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84888632769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888632769&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2013.06.022

DO - 10.1016/j.mayocp.2013.06.022

M3 - Article

C2 - 24079678

AN - SCOPUS:84888632769

VL - 88

SP - 1075

EP - 1084

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 10

ER -