Cost Analysis for Minimally Invasive Mitral Valve Surgery: A Single-Centre Canadian Study

Background: Stakeholders within a publicly funded healthcare system have a duty to consider costs and economics, to utilize finite resources in the most effective manner. We aimed to quantify the postoperative costs associated with mitral valve repair (MVR) at the Foothills Medical Centre in Calgary, Canada. Methods: A retrospective review of patients who underwent MVR from January 2020 to November 2023 was performed. For patients undergoing minimally invasive mitral valve surgery (MIMVS), a postoperative rapid recovery (RR) protocol was introduced. Postoperative costs were analyzed for 3 comparator groups: MIMVS with RR (MIMVS-RR), MIMVS without RR, , and median sternotomy. Results: Care in the cardiovascular intensive care unit (CVICU) is 2.83 times more expensive than care on the cardiac surgery ward. Length of stay (LOS) in the CVICU was identified to be the primary driver of postoperative costs. The CVICU LOS and total LOS for sternotomy patients was longer than those of MIMVS patients. This difference translated to increased postoperative costs for sternotomy compared to MIMVS on a per-patient basis. The postoperative costs associated with sternotomy are 1.42 times higher than those for MIMVS-RR. When modelled with 200 patients, MIMVS-RR represents a postoperative cost-savings of $3.657 million CAD, compared to sternotomy. Conclusions: Following MVR, a minimally invasive approach demonstrates cost-savings, compared to a sternotomy. Reduced CVICU LOS was the primary driver of cost-savings for MIMVS. Further analysis and investigations are required to fully quantify the true economic benefits of MIMVS-RR at our centre.