Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings

Eugene A. Grossi, Scott Goldman, J. Alan Wolfe, John Mehall, J. Michael Smith, Gorav Ailawadi, Arash Salemi, Matt Moore, Alison Ward, Candace Gunnarsson

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Objective Small series of thoracotomy for mitral valve repair have demonstrated clinical benefit. This multi-institutional administrative database analysis compares outcomes of thoracotomy and sternotomy approaches for mitral repair.

Results Expert rule analysis positively identified thoracotomy in 847 and sternotomy in 566. Propensity matching created 2 groups of 367. Mortalities were similar (thoracotomy 1.1% vs sternotomy 1.9%). Sepsis and other infections were significantly lower with thoracotomy (1.1% vs 4.4%). After adjustment for hospital differences, thoracotomy carried a 17.2% lower hospitalization cost (-$8289) with a 2-day stay reduction. Readmission rates were significantly lower with thoracotomy (26.2% vs 35.7% at 30 days and 31.6% vs 44.1% at 90 days). Thoracotomy was more common in southern and northeastern hospitals (63% vs 37% and 64% vs 36%, respectively), teaching hospitals (64% vs 36%) and larger hospitals (>600 beds, 78% vs 22%).

Conclusions Relative to sternotomy, thoracotomy for mitral repairs provides similar mortality, less morbidity, fewer infections, shorter stay, and significant cost savings during primary admission. The markedly lower readmission rates for thoracotomy will translate into additional institutional cost savings when a penalty on hospitals begins under the Affordable Care Act's Hospital Readmissions Reduction Program.

Original languageEnglish (US)
Pages (from-to)2818-2822.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

ASJC Scopus subject areas

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

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    Grossi, E. A., Goldman, S., Wolfe, J. A., Mehall, J., Smith, J. M., Ailawadi, G., Salemi, A., Moore, M., Ward, A., & Gunnarsson, C. (2014). Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings. Journal of Thoracic and Cardiovascular Surgery, 148(6), 2818-2822.e3. https://doi.org/10.1016/j.jtcvs.2014.08.029