Health economic and hospital resource use in isolated mitral valve repair in more than 8000 patients: Robotic versus nonrobotic approaches

Objective To explore the health economics and hospital resource use in isolated mitral valve repair (MVr) in patients undergoing robotic versus nonrobotic surgical approaches. Methods We conducted a retrospective cohort study using the Premier Healthcare Database for patients who underwent isolated MVr surgery from 2019 to 2024. Hospital chargemaster data was text mined for "robotic," and patient and procedure characteristic and outcomes were stratified by robotic versus traditional surgical approaches. Differences in outcomes (MVr hospitalization cost, intensive care unit [ICU] days, length of stay, operating room time, prolonged ventilation, and 30-day cardiovascular [CV] readmissions) were estimated using generalized linear modeling with adjustment for patient, procedure, and hospital characteristics. Results A total of 8025 patients received an isolated MVr (mean age 57.8 ± 17.7 years, 39.4% female). Overall, 780 (9.7%) of the procedures were performed robotically, with robotic use generally increasing each year from 7.7% in 2019 to 14.7% in 2024. Compared with traditional (nonrobotic) surgery, robotic cases cost 12% more ($57,678 robotic vs $51,530 nonrobotic, P < .0001). However, patients who underwent robotic surgery spent 14% less time in the ICU (2.4 vs 2.8 days, P < .0001) and 16% less time in the hospital overall (5.7 vs 6.8 days, P < .0001). Robot use was also associated with lower 30-day CV readmission rates (3.1% vs 4.9%, P = .0215). There was no statistical difference in operating room time or prolonged ventilation use. Conclusions Robotic use in isolated MVr procedures has increased ∼7% over the last 5 years. This signals ongoing physician and hospital adoption of robotic use in MVr. The use of innovative robotic interventions comes at an increased cost to the hospital but may be associated with procedural efficiencies, including shorter ICU days and shorter overall hospital stays, as well as lower 30-day CV readmission rates, which may have important clinical and economic benefits for patients and health care systems.