A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery

Iribarne, Alexander; Easterwood, Rachel; Russo, Mark J.; Wang, Y. Claire; Yang, Jonathan; Hong, Kimberly N.; Smith, Craig R.; Argenziano, Michael

doi:10.1016/j.jtcvs.2011.04.038

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 142, Issue 6 , Pages 1507-1514, December 2011

A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery

Alexander Iribarne, MD, MS
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
Rachel Easterwood, BA
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
Mark J. Russo, MD, MS
- Section of Cardiac and Thoracic Surgery, University of Chicago Medical Center, Chicago, Ill
Y. Claire Wang, MD, ScD
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
Jonathan Yang, MD
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
Kimberly N. Hong, MHSA
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
Craig R. Smith, MD
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
Michael Argenziano, MD
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
- Address for reprints: Michael Argenziano, MD, Columbia University Medical Center, Milstein Hospital Building, Room 7-435, 177 Fort Washington Ave, New York, NY 10032.

Received 3 October 2010; received in revised form 20 March 2011; accepted 11 April 2011. published online 13 June 2011.

Objective

The aim of this study was to compare the cost and effectiveness of a minimally invasive (MI) versus traditional sternotomy (ST) approach for mitral valve surgery (MVS).

Methods

From January 1, 2003, to December 31, 2008, a total of 847 patients underwent isolated MVS at our institution. Propensity matching on 22 clinical variables was carried out to generate a study cohort of 434 patients (217 matched pairs). Direct and indirect costs from the hospital perspective were retrospectively obtained from our finance department. Total hospital costs were further stratified into 13 standardized institutional billing categories. In addition, data on morbidity, mortality, discharge location, hospital readmissions within 1 year, and freedom from reoperation were obtained.

Results

Compared with ST, MIMVS was associated with a $9054 ± $3302 lower mean total hospital cost (P = .006), driven largely by a reduction in direct (P = .003) versus indirect costs (P = .06). Among the 13 billing categories, MIMVS was associated with a significant reduction in costs of cardiac imaging (P = .004), laboratory tests (P = .005), boarding and nursing (P = .001), and radiology (P = .002). More patients in the ST group required intubation for more than 72 hours (P = .019); however, there were no differences in morbidity or long-term survival (P = .334). A higher proportion of MI patients were discharged home with no nursing services (P = .018), and a higher proportion of ST patients required readmission within 1 year (P = .023). There were no differences in freedom from reoperation between groups (P = .574).