Background: Heart valve disease is very common, with approximately 5 million people diagnosed with this disease annually in the United States. There has been substantial innovation in the technologies and techniques of surgical repair and replacement over the past decade. However, there is little information that allows the potential time savings associated with these technologies and techniques to be quantified from the hospital perspective.
Objectives: The study objective was to estimate the variable cost per operating room (OR) minute in valvular procedures – aortic valve replacement (AVR), mitral valve replacement (MVR) and mitral valve repair (MVRepair) – and determine if there is a difference in OR cost per minute between traditional sternal versus less invasive right thoracotomy surgical techniques.
Methods: The Premier database was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. Patients were identified using the International Classification of Diseases, 9th Revision (ICD-9) procedure codes. Propensity score matching created cohorts adjusted for patient differences and surgical approach –any sternal incision (Sternal) or right thoracotomy (RT). Regression analysis was performed to estimate the OR cost per minute based on heart valve procedure.
Results: There were 2,656 heart valve procedures – 1,604 AVR, 434 MVR and 618 MVRepair – that met the inclusion criteria. The mean OR cost per minute for AVR procedures was $26.49 and $25.16 (p <0.01) for Sternal and RT, respectively. MVR procedures by surgical approach had a mean OR cost per minute of $25.66 and $25.00 and (p NS) for Sternal and RT, respectively. MVRepair procedures by surgical approach had a mean OR cost per minute of $25.17 and $24.40 and (p NS) for Sternal and RT, respectively. The overall estimate of the OR cost per minute for valvular procedures was $25.99.
Conclusions: Quantifying the variable cost of an OR minute from a multi-institution database provides researchers with an important benchmark to use in economic evaluations of valvular procedures.
Mitral valve pathology in severely impaired left ventricles can be successfully managed using a right-sided minimally invasive surgical approach
