Yang NaYoung K, Soliman Fady K, Pepe Russell J, Palte Nadia K, Yoo Jin, Nithikasem Sorasicha, Laraia Kayla N, Chakraborty Abhishek, Chao Joshua C, Sunagawa Gengo, Takebe Manabu, Lemaire Anthony, Ikegami Hirohisa, Russo Mark J, Lee Leonard Y
Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Robert Wood Johnson University Hospital, New Brunswick, NJ.
JTCVS Open. 2023 Jun 28;15:72-80. doi: 10.1016/j.xjon.2023.06.007. eCollection 2023 Sep.
To investigate the effect of minimally invasive cardiac surgery (MICS) on resource utilization, cost, and postoperative outcomes in patients undergoing left-heart valve operations.
Data were retrospectively reviewed for patients undergoing single-valve surgery (eg, aortic valve replacement, mitral valve replacement, or mitral valve repair) at a single center from 2018 to 2021, stratified by surgical approach: MICS vs full sternotomy (FS). Baseline characteristics and postoperative outcomes were compared. Primary outcome was high resource utilization, defined as direct procedure cost higher than the third quartile or either postoperative LOS ≥7 days or 30-day readmission. Secondary outcomes were direct cost, length of stay, 30-day readmission, in-hospital and 30-day mortality, and major morbidity. Multiple regression analysis was conducted, controlling for baseline characteristics, operative approach, valve operation, and lead surgeon to assess high resource utilization.
MICS was correlated with a significantly lower rate of high resource utilization (MICS, 31.25% [n = 115] vs FS 61.29% [n = 76]; < .001). Median postoperative length of stay (MICS, 4 days [range, 3-6 days] vs FS, 6 days [range, 4 to 9 days]; < .001) and direct cost (MICS, $22,900 [$19,500-$28,600] vs FS, $31,900 [$25,900-$50,000]; < .001) were lower in the MICS group. FS patients were more likely to experience postoperative atrial fibrillation ( = .040) and renal failure ( = .027). Other outcomes did not differ between groups. Controlling for stratified Society of Thoracic Surgeons predicted risk of mortality, cardiac valve operation, and lead surgeon, FS demonstrated increased likelihood of high resource utilization ( < .001).
MICS for left-heart valve pathology demonstrated improved postoperative outcomes and resource utilization.
探讨微创心脏手术（MICS）对接受左心瓣膜手术患者的资源利用、成本及术后结局的影响。
回顾性分析2018年至2021年在单一中心接受单瓣膜手术（如主动脉瓣置换术、二尖瓣置换术或二尖瓣修复术）患者的数据，按手术方式分层：MICS与全胸骨切开术（FS）。比较基线特征和术后结局。主要结局为高资源利用，定义为直接手术成本高于第三四分位数或术后住院时间（LOS）≥7天或30天再入院。次要结局为直接成本、住院时间、30天再入院、院内及30天死亡率和主要并发症。进行多元回归分析，控制基线特征、手术方式、瓣膜手术和主刀医生以评估高资源利用情况。
MICS与高资源利用率显著降低相关（MICS为31.25% [n = 115]，FS为61.29% [n = 76]；P <.001）。MICS组术后中位住院时间（MICS为4天 [范围3 - 6天]，FS为6天 [范围4至9天]；P <.001）和直接成本（MICS为22,900美元 [19,500 - 28,600美元]，FS为31,900美元 [25,900 - 50,000美元]；P <.001）更低。FS患者更易发生术后房颤（P = 0.040）和肾衰竭（P = 0.027）。其他结局在两组间无差异。控制胸外科医师协会分层预测的死亡风险、心脏瓣膜手术和主刀医生后，FS显示高资源利用的可能性增加（P <.001）。
用于左心瓣膜病变的MICS显示出改善的术后结局和资源利用情况。
