Resource utilization for minimally invasive direct and standard coronary artery bypass grafting

Background. Minimally invasive direct coronary artery bypass grafting (MIDCABG) has been recently reintroduced into the cardiac surgical armamentarium for selected patients with suitable coronary anatomy. We hypothesized that MIDCABG had the potential for similar immediate results with decreased perioperative morbidity and decreased resource utilization compared with standard coronary artery bypass grafting (CABG). Methods. From January 1996 to August 1996, 17 MIDCABG patients were compared with 33 patients with left ventricular ejection fraction greater than 0.50 who underwent CABG with standard technique. No significant differences were observed between the two groups for preoperative variables that are known to affect cost and resource utilization. Length of stay in the hospital was 2.5 ± 0.8 days for MIDCABG and 5.9 ± 2 days for CABG (p < 0.0001); length of stay in the intensive care unit was 12.3 ± 3.3 hours for MIDCABG compared to 32.3 ± 12.6 hours for the CABG group (p < 0.0001). Results. Forty-one percent of MIDCABG patients were extubated in the operating room and 59% were discharged home on the first or second postoperative day versus none in the CABG group (p < 0.0001). Significantly less morbidity was observed in the MIDCABG group compared with CABG. Total ratio of cost-to-charge was $12,885 ± $1,511 for MIDCABG and $21,260 ± $5,497 for CABG (p < 0.0001), with an average savings of $8,375. Conclusions. Minimally invasive CABG is associated with significant reduction of resource utilization and morbidity related to initial hospitalization compared with CABG.