Left anterior small thoracotomy versus coronary artery bypass graft for single-vessel occlusion - A cost identification analysis

Objectives: Single-vessel bypass can often be accomplished through less inv asive techniques than conventional coronary artery bypass graft (CABG) at s ubstantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thorac otomy (LAST). Methods: Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. Th e study groups consisted of 50 patients who underwent LAST and 28 who under went single-vessel conventional CABG during 1995 and 1996. A subsequent val idation sample of 50 patients who underwent LAST was also analyzed. Hospita lization costs were estimated using a relative Value unit methodology and w ere risk-adjusted for both perioperative risk factors and changes in operat ing room technology. Results: Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differenc es in surgical costs reflecting over 62% of this overall difference. Differ ences in average length of stay were under a half-day (10.0 for LAST vs. 10 .46 for CABG). Only one inpatient fatality was reported; therefore, no infe rence regarding mortality differences could be made. Conclusions: LAST is substantially less costly than conventional surgery, a nd the savings are potentially greater if hospital length of stay is reduce d to a clinically recommended time of 2 days.