Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: A multi-institution analysis of 'real world' data

Evelio Rodriguez, S. Chris Malaisrie, John R. Mehall, Matt Moore, Arash Salemi, Gorav Ailawadi, Candace Gunnarsson, Alison F. Ward, Eugene A. Grossi

Research output: Contribution to journalArticle

Abstract

Methods: The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.

Results: AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n=1572) and by aStern (n=3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p<0.01), teaching hospitals (66% vs 58%; p<0.01) and larger hospitals (47% vs 30%; p<0.01). There was significantly less blood product cost associated with RAT (1381 vs 1912; p<0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern (38,769 vs 42,656; p<0.01).

Background: Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.

Conclusions: Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.

Original languageEnglish (US)
Pages (from-to)846-852
Number of pages7
JournalJournal of Medical Economics
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Fingerprint

Sternotomy
Thoracotomy
Aortic Valve
Costs and Cost Analysis
Databases
Health Facility Size
Hospital Records
Hospital Costs
Patient Rights
Teaching Hospitals
Inpatients
Regression Analysis

Keywords

  • Aortic valve
  • Cost savings
  • Minimally invasive surgery
  • Outcomes

ASJC Scopus subject areas

  • Health Policy

Cite this

Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches : A multi-institution analysis of 'real world' data. / Rodriguez, Evelio; Malaisrie, S. Chris; Mehall, John R.; Moore, Matt; Salemi, Arash; Ailawadi, Gorav; Gunnarsson, Candace; Ward, Alison F.; Grossi, Eugene A.

In: Journal of Medical Economics, Vol. 17, No. 12, 01.12.2014, p. 846-852.

Research output: Contribution to journalArticle

Rodriguez, Evelio ; Malaisrie, S. Chris ; Mehall, John R. ; Moore, Matt ; Salemi, Arash ; Ailawadi, Gorav ; Gunnarsson, Candace ; Ward, Alison F. ; Grossi, Eugene A. / Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches : A multi-institution analysis of 'real world' data. In: Journal of Medical Economics. 2014 ; Vol. 17, No. 12. pp. 846-852.
@article{e26f9522976d4c1195190f7494ec1f36,
title = "Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: A multi-institution analysis of 'real world' data",
abstract = "Methods: The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.Results: AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n=1572) and by aStern (n=3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63{\%} vs 36{\%}; p<0.01), teaching hospitals (66{\%} vs 58{\%}; p<0.01) and larger hospitals (47{\%} vs 30{\%}; p<0.01). There was significantly less blood product cost associated with RAT (1381 vs 1912; p<0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern (38,769 vs 42,656; p<0.01).Background: Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.Conclusions: Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.",
keywords = "Aortic valve, Cost savings, Minimally invasive surgery, Outcomes",
author = "Evelio Rodriguez and Malaisrie, {S. Chris} and Mehall, {John R.} and Matt Moore and Arash Salemi and Gorav Ailawadi and Candace Gunnarsson and Ward, {Alison F.} and Grossi, {Eugene A.}",
year = "2014",
month = "12",
day = "1",
doi = "10.3111/13696998.2014.953681",
language = "English (US)",
volume = "17",
pages = "846--852",
journal = "Journal of Medical Economics",
issn = "1369-6998",
publisher = "Informa Healthcare",
number = "12",

}

TY - JOUR

T1 - Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches

T2 - A multi-institution analysis of 'real world' data

AU - Rodriguez, Evelio

AU - Malaisrie, S. Chris

AU - Mehall, John R.

AU - Moore, Matt

AU - Salemi, Arash

AU - Ailawadi, Gorav

AU - Gunnarsson, Candace

AU - Ward, Alison F.

AU - Grossi, Eugene A.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Methods: The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.Results: AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n=1572) and by aStern (n=3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p<0.01), teaching hospitals (66% vs 58%; p<0.01) and larger hospitals (47% vs 30%; p<0.01). There was significantly less blood product cost associated with RAT (1381 vs 1912; p<0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern (38,769 vs 42,656; p<0.01).Background: Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.Conclusions: Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.

AB - Methods: The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.Results: AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n=1572) and by aStern (n=3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p<0.01), teaching hospitals (66% vs 58%; p<0.01) and larger hospitals (47% vs 30%; p<0.01). There was significantly less blood product cost associated with RAT (1381 vs 1912; p<0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern (38,769 vs 42,656; p<0.01).Background: Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.Conclusions: Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.

KW - Aortic valve

KW - Cost savings

KW - Minimally invasive surgery

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=84911932428&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911932428&partnerID=8YFLogxK

U2 - 10.3111/13696998.2014.953681

DO - 10.3111/13696998.2014.953681

M3 - Article

C2 - 25111633

AN - SCOPUS:84911932428

VL - 17

SP - 846

EP - 852

JO - Journal of Medical Economics

JF - Journal of Medical Economics

SN - 1369-6998

IS - 12

ER -