Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
J Thorac Cardiovasc Surg. 2018 Aug;156(2):611-616.e3. doi: 10.1016/j.jtcvs.2018.03.108. Epub 2018 Apr 3.
Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization.
Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission.
A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P = .78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P = .01) and shorter ventilator times (3.7 vs 6.0 hours, P < .0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P = .235) with mini-MVR having lower ancillary ($1645 vs $2652, P = .001) and blood costs ($383 vs $1058, P = .001). These savings were offset by longer surgical times (291 vs 234 minutes, P < .0001) with greater surgical ($7645 vs $7293, P = .0001) and implant costs ($1148 vs $748, P = .03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different.
In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.
微创二尖瓣手术（mini-MVR）有许多相关的益处。然而，许多研究未能包括高危患者。我们假设，在一个有代表性的队列中采用微创方法可以提供极好的结果，同时减少资源的利用。
从 2011 年到 2016 年，我们将二尖瓣手术的记录与机构财务记录进行了配对。根据手术方法对患者进行分层，并通过倾向评分匹配来平衡术前差异。主要关注的结果是资源的利用，包括成本、出院到医疗机构和再入院。
共有 478 名患者接受了二尖瓣手术（21%为 mini-MVR），在匹配后平衡（每组 n=74），18%的患者患有非退行性二尖瓣疾病。结果非常好，主要发病率的发生率相似（mini-MVR 为 9.5%，常规手术为 10.8%，P=0.78）。Mini-MVR 病例的输血率较低（11%比 27%，P=0.01），呼吸机使用时间较短（3.7 比 6.0 小时，P<0.0001）。平均总住院费用相当（49703 美元比 54970 美元，P=0.235），但 mini-MVR 的辅助费用较低（1645 美元比 2652 美元，P=0.001）和血液成本较低（383 美元比 1058 美元，P=0.001）。这些节省被较长的手术时间（291 比 234 分钟，P<0.0001）、更高的手术（7645 美元比 7293 美元，P=0.0001）和植入物成本（1148 美元比 748 美元，P=0.03）所抵消。出院到医疗机构的比例（9.6%比 16.2%）和再入院率（9.6%比 4.1%）没有统计学差异。
在真实世界的队列中，mini-MVR 继续表现出极好的结果，同时具有良好的资源利用情况。mini-MVR 较高的手术和植入物成本被减少的输血和辅助需求所抵消，导致总体住院费用相当。
