Key result
Concomitant left atrial appendage closure during cardiac surgery increased adjusted costs by $10,602 (95% CI, $4078-$17,126) without significantly impacting 30-day mortality.
Why the study?
With the rising incidence of AF, LAAC during cardiac surgery remains an important adjunct, prompting this evaluation of trends, resource utilization, and potential disparities.
What are the temporal trends, costs, and short-term outcomes associated with concomitant left atrial appendage closure during cardiac surgery?
Cohort
Yes
What are the temporal trends, costs, and short-term outcomes associated with concomitant left atrial appendage closure during cardiac surgery?
Mean Difference: 10602 (95% CI 4078–17126)
Concomitant LAAC during cardiac surgery is increasing in utilization and adds approximately $10,600 in costs without significantly impacting 30-day mortality or readmission.
Concomitant LAAC increases costs without short-term gains; hypothesis-generating for selective use pending randomized long-term data.
Objective: With the rising incidence of atrial fibrillation, left atrial appendage closure (LAAC) at the time of cardiac surgery remains an important adjunct. The present study characterized trends, associated resource utilization, and potential disparities in the use of left atrial appendage exclusion. Methods: Using a Society of Thoracic Surgeons regional academic collaborative database, we queried all adult patients undergoing coronary and valve procedures with concomitant LAAC between 2015 and 2021. Trends in LAAC, as well as the technique for closure, were evaluated. Multilevel hierarchical logistic modeling was applied to delineate factors associated with LAAC, accounting for patient and operative characteristics. Generalized linear models were developed to perform risk-adjusted incremental cost analysis. Results: < .001). LAAC patients were older, but less commonly insulin-dependent diabetics or on dialysis. Female sex, redo, and urgent operative status had lower risk-adjusted odds of LAAC. Although LAAC was associated with longer bypass time, there was no significant association with 30-day mortality or 30-day readmission. LAAC was associated with an incremental increase in adjusted costs by $10,602 (95% confidence interval, $4078-$17,126). Conclusions: Rates of LAAC are increasing but less common among female patients, as well as those requiring urgent/emergent interventions. LAAC did not significantly impact short-term mortality. Our results suggest that LAAC may be a high-value intervention among patient populations that have the greatest potential to derive its benefits.
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Sanaiha et al. (2024) conducted a cohort in Atrial fibrillation / Coronary and valve procedures. Concomitant left atrial appendage closure vs. No left atrial appendage closure was evaluated on Adjusted costs (MD 10602, 95% CI 4078-17126). Concomitant left atrial appendage closure during cardiac surgery increased adjusted costs by $10,602 (95% CI, $4078-$17,126) without significantly impacting 30-day mortality.
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