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 arm amentarium for selected patients with suitable coronary anatomy. We hy pothesized that MIDCABG had the potential for similar immediate result s with decreased perioperative morbidity and decreased resource utiliz ation compared with standard coronary artery bypass grafting (CABG). M ethods. From January 1996 to August 1996, 17 MIDCABG patients were com pared 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 vari ables that are known to affect cost and resource utilization. Length o f 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 pa tients were extubated in the operating room and 59% were discharged ho me on the first or second postoperative day versus none in the CABG gr oup (p < 0.0001). Significantly less morbidity was observed in the MID CABG group compared with CABG. Total ratio of cost-to-charge was $12,8 85 +/- $1,511 for MIDCABG and $21,260 +/- $5,497 for CABG (p < 0.0001) , with an average savings of $8,375. Conclusions. Minimally invasive C ABG is associated with significant reduction of resource utilization a nd morbidity related to inital hospitalization compared with CABG. (C) 1997 by The Society of Thoracic Surgeons.