Trends in Open Aortic Valve Surgery in the United States: Descriptive Analysis of Sociodemographic Factors in Patient Selection

Background Minimally invasive surgical approaches offers patient benefit, such as expedited recovery, and could reduce hospital cost. This study examines how sociodemographic factors influences surgical approach for aortic valve surgery. Methods We used data from The Society of Thoracic Surgeons’ database to model selection into minimally invasive surgery vs. traditional sternotomy. Pair-matches were created between two identity types: male-vs-female sex and White-vs-Black race. Patients were matched on facility and other covariates. These pair-matches were summarized using generalized linear mixed models (logit-link), regressing surgery type on the relevant identity, with random effects for facility and matched pair. Additionally, a regional analysis summarizing variation in the mortality-risk profiles of patients was conducted. Results From 2015 to 2020, of the patients that met inclusion criteria, 68,956 patients underwent traditional sternotomy and 23,811 underwent minimally invasive surgery. For matched pairs of the examined covariate, the null hypothesis was that each patient would have the same odds of receiving each surgical approach. Our models estimate the odds ratio for receiving the minimally invasive surgery are 1.13 and 1.56 times higher for female and White patients respectively (both p-values <= 0.005). We also identified regional variation across levels of mortality-risk score and race. Conclusions Our study demonstrates a pattern of variation in sorting in minimally invasive surgical aortic valve replacement vs traditional sternotomy via patient sex and race. These findings infer non-medical features guide patient candidacy for surgical approach, even within the same facility.