Minimally invasive approach associated with lower resource utilization after aortic and mitral valve surgery

Figures

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  High-resource utilization overall and by definition stratified by operative approach.

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  Figure 1. Comparison of high-resource utilization overall and separated by definition: direct procedure cost higher than the third quartile or either postoperative length of stay (LOS) ≥7 days or 30-day readmission between patients who underwent valve operations stratified by operative approach (full sternotomy vs minimally invasive surgery). By both separate definitions and composite high resource utilization, we find that patients who underwent full sternotomy cardiac valve operations experienced significantly higher rates of high resource utilization. HRU, High resource utilization; OR, odds ratio.

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  Figure 2. Comparison of (A) postoperative length of stay, and (B) total direct cost of patients who underwent valve operations stratified by operative approach. Patients who underwent full sternotomy experienced both significantly longer postoperative length of stay and higher direct costs.

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  Figure 3. Postoperative complications, mortality, and readmission rates after left-heart valve surgery in patient cohorts stratified by operative approach. No significant difference was observed in mortality, readmission, and postoperative complications. Patients who underwent the full sternotomy approach were more likely to experience postoperative atrial fibrillation and renal failure. ICU, Intensive care unit.

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  Figure 4. Forest plot of nominal logistic regression depicting full sternotomy (FS) vs minimally invasive cardiac surgery (MICS) and their respective odds of patients experiencing high resource utilization (HRU) controlled for lead surgeon, operation (aortic valve replacement [AVR], mitral valve replacement [MVR], or mitral valve [MV] repair), and Society of Thoracic Surgeons predicted risk of mortality score stratified into low, medium, and high risk defined as 1% to 4%, 4% to 8%, and ≥8% risk, respectively. The model showed that patients who underwent FS had 3.28 times the odds of HRU compared with their counterparts undergoing MICS (FS OR, 3.28; 95% CI, 1.76-6.13 vs MICS OR, 0.30; 95% CI, 0.16-0.57; P < .001).

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  Figure 5. Outcomes of minimally invasive approach to left-heart valve surgery. Our results show that minimally invasive cardiac surgery (MICS) approach correlated with lower rates of high resource utilization, shorter length of stay (LOS), and lower direct cost relative to full sternotomy with no concomitant increase in postoperative complication rate. AVR, Aortic valve replacement; MVR, mitral valve replacement; MV, mitral valve.

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