Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes

Robert B. Hawkins, J. Hunter Mehaffey, Samuel M. Kessel, Jolian J. Dahl, Irving L. Kron, John A. Kern, Leora T. Yarboro, Gorav Ailawadi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. Methods: Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. Results: A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P =.78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P =.01) and shorter ventilator times (3.7 vs 6.0 hours, P <.0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P =.235) with mini-MVR having lower ancillary ($1645 vs $2652, P =.001) and blood costs ($383 vs $1058, P =.001). These savings were offset by longer surgical times (291 vs 234 minutes, P <.0001) with greater surgical ($7645 vs $7293, P =.0001) and implant costs ($1148 vs $748, P =.03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different. Conclusions: In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.

Original languageEnglish (US)
Pages (from-to)611-616.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number2
DOIs
StatePublished - Aug 2018
Externally publishedYes

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Mitral Valve
Costs and Cost Analysis
Hospital Costs
Propensity Score
Minimally Invasive Surgical Procedures
Mechanical Ventilators
Operative Time
Morbidity

Keywords

  • mini thoracotomy
  • minimally invasive
  • mitral valve
  • resource utilization

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. / Hawkins, Robert B.; Mehaffey, J. Hunter; Kessel, Samuel M.; Dahl, Jolian J.; Kron, Irving L.; Kern, John A.; Yarboro, Leora T.; Ailawadi, Gorav.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 156, No. 2, 08.2018, p. 611-616.e3.

Research output: Contribution to journalArticle

Hawkins, Robert B. ; Mehaffey, J. Hunter ; Kessel, Samuel M. ; Dahl, Jolian J. ; Kron, Irving L. ; Kern, John A. ; Yarboro, Leora T. ; Ailawadi, Gorav. / Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. In: Journal of Thoracic and Cardiovascular Surgery. 2018 ; Vol. 156, No. 2. pp. 611-616.e3.
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abstract = "Objectives: Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. Methods: Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. Results: A total of 478 patients underwent mitral surgery (21{\%} mini-MVR) and were balanced after matching (n = 74 per group), with 18{\%} of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5{\%} mini-MVR vs 10.8{\%} conventional, P =.78). Mini-MVR cases had lower rates of transfusion (11{\%} vs 27{\%}, P =.01) and shorter ventilator times (3.7 vs 6.0 hours, P <.0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P =.235) with mini-MVR having lower ancillary ($1645 vs $2652, P =.001) and blood costs ($383 vs $1058, P =.001). These savings were offset by longer surgical times (291 vs 234 minutes, P <.0001) with greater surgical ($7645 vs $7293, P =.0001) and implant costs ($1148 vs $748, P =.03). Rates of discharge to a facility (9.6{\%} vs 16.2{\%}) and readmission (9.6{\%} vs 4.1{\%}) were not statistically different. Conclusions: In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.",
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AU - Mehaffey, J. Hunter

AU - Kessel, Samuel M.

AU - Dahl, Jolian J.

AU - Kron, Irving L.

AU - Kern, John A.

AU - Yarboro, Leora T.

AU - Ailawadi, Gorav

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N2 - Objectives: Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. Methods: Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. Results: A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P =.78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P =.01) and shorter ventilator times (3.7 vs 6.0 hours, P <.0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P =.235) with mini-MVR having lower ancillary ($1645 vs $2652, P =.001) and blood costs ($383 vs $1058, P =.001). These savings were offset by longer surgical times (291 vs 234 minutes, P <.0001) with greater surgical ($7645 vs $7293, P =.0001) and implant costs ($1148 vs $748, P =.03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different. Conclusions: In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.

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