Abstract 13224: Minimally Invasive versus Traditional Sternotomy Mitral Valve Surgery: A Cost-Effectiveness Analysis
Purpose: The goal of this study was to compare the cost-effectiveness of mitral valve surgery (MVS) performed through a minimally invasive (MI) vs median sternotomy (ST) approach.
Methods: From 1/1/03–12/31/08, 847 isolated mitral valve operations were performed at our institution (348 ST, 499 MI). All MI cases were performed via mini-thoracotomy. Propensity matching on 18 preoperative risk factors was done using a logistic regression model. Cost data was obtained from our hospital billing system using standardized UB-92 forms. Total cost and service-specific costs between the two approaches were compared.
Results: The propensity analysis generated 211 matched pairs for a total analysis cohort of 422 patients. There was no significant difference in major baseline characteristics after propensity matching (model c-statistic=0.813). MI surgery was associated with a 6.9 minute longer cross-clamp time (XCT) (p=0.021) and a 23.7 minute longer bypass time (CBT) compared to ST (p<0.001). MI patients had a 2.1 day shorter length of stay (LOS) of 7.1 days compared to ST (p=0.001). There was no difference in major in-hospital complications (p=0.068) or 30-day survival (p=0.703) between groups. Average survival follow up time was 3.2 years, and there was no difference in Kaplan-Meier survival between groups (p=0.764). The MI approach was associated with a $9,050 lower total hospital cost (MI=$41,000; ST=$50,050; p=0.006). Table 1 shows the distribution of costs among select major billing categories. There was also a significant difference in discharge disposition with 67.2% of MI (n=135) vs. 56.1% (n=111) of ST patients discharged home without nursing services (p=0.015).
Conclusions: While MI surgery is associated with slightly longer XCT and CBT, MI has equivalent efficacy as ST with respect to morbidity and long-term survival. Moreover, MI surgery is associated with reduced LOS and total hospital costs. Thus, the MI approach is more cost-effective than the ST approach for MVS.
- © 2010 by American Heart Association, Inc.