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Background <p>This study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement, using a nationwide population-based dataset from Taiwan.</p> Methods <p>Patients who underwent isolated surgical MVR between 2016 and 2021 were identified from Taiwan’s National Health Insurance Research Database. A total of 5,736 patients met inclusion criteria: 5,547 underwent conventional sternotomy MVR (CSMVR), and 113 received robot-assisted MVR (RAMVR). To reduce confounding, inverse probability of treatment weighting (IPTW) was applied using age, sex, and Charlson Comorbidity Index as covariates, yielding a weighted cohort of 5,660 CSMVR and 5,640 RAMVR cases for outcome analysis.</p> Results <p>After IPTW adjustment, RAMVR was associated with significantly better survival (hazard ratio: 0.37; 95% confidence interval: 0.33–0.41; p &lt; 0.01), shorter hospital stay (16.5 vs. 22.7&#xa0;days, p &lt; 0.01), and shorter intensive care unit stay (4.4 vs. 9.1&#xa0;days, p &lt; 0.01). RAMVR patients also had lower rates of dialysis and stroke. One-year post-discharge medical costs were significantly lower in the RAMVR group (USD 1,640 vs. 4,003, p &lt; 0.01). Although inpatient costs appeared lower for RAMVR, this reflects the exclusion of patient-borne expenses for robotic equipment not reimbursed by insurance.</p> Conclusion <p>In this national population-based analysis, RAMVR was associated with better mid-term survival, shorter hospital stays, and reduced medical costs compared with conventional sternotomy. These findings support the use of robotic-assisted surgery as a safe and effective alternative in selected patients undergoing mitral valve replacement.</p>

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Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan’s National Health Insurance Research Database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月16日

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  • Yu-san Chien,
  • Ching-hu Chung,
  • Jiun-yi Li

摘要

Background

This study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement, using a nationwide population-based dataset from Taiwan.

Methods

Patients who underwent isolated surgical MVR between 2016 and 2021 were identified from Taiwan’s National Health Insurance Research Database. A total of 5,736 patients met inclusion criteria: 5,547 underwent conventional sternotomy MVR (CSMVR), and 113 received robot-assisted MVR (RAMVR). To reduce confounding, inverse probability of treatment weighting (IPTW) was applied using age, sex, and Charlson Comorbidity Index as covariates, yielding a weighted cohort of 5,660 CSMVR and 5,640 RAMVR cases for outcome analysis.

Results

After IPTW adjustment, RAMVR was associated with significantly better survival (hazard ratio: 0.37; 95% confidence interval: 0.33–0.41; p < 0.01), shorter hospital stay (16.5 vs. 22.7 days, p < 0.01), and shorter intensive care unit stay (4.4 vs. 9.1 days, p < 0.01). RAMVR patients also had lower rates of dialysis and stroke. One-year post-discharge medical costs were significantly lower in the RAMVR group (USD 1,640 vs. 4,003, p < 0.01). Although inpatient costs appeared lower for RAMVR, this reflects the exclusion of patient-borne expenses for robotic equipment not reimbursed by insurance.

Conclusion

In this national population-based analysis, RAMVR was associated with better mid-term survival, shorter hospital stays, and reduced medical costs compared with conventional sternotomy. These findings support the use of robotic-assisted surgery as a safe and effective alternative in selected patients undergoing mitral valve replacement.