title: A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery.
abstract: OBJECTIVE
  The aim of this study was to compare the cost and effectiveness of a minimally invasive (MI) versus traditional sternotomy (ST) approach for mitral valve surgery (MVS).
  
  
  METHODS
  From January 1, 2003, to December 31, 2008, a total of 847 patients underwent isolated MVS at our institution. Propensity matching on 22 clinical variables was carried out to generate a study cohort of 434 patients (217 matched pairs). Direct and indirect costs from the hospital perspective were retrospectively obtained from our finance department. Total hospital costs were further stratified into 13 standardized institutional billing categories. In addition, data on morbidity, mortality, discharge location, hospital readmissions within 1 year, and freedom from reoperation were obtained.
  
  
  RESULTS
  Compared with ST, MIMVS was associated with a $9054 ± $3302 lower mean total hospital cost (P = .006), driven largely by a reduction in direct (P = .003) versus indirect costs (P = .06). Among the 13 billing categories, MIMVS was associated with a significant reduction in costs of cardiac imaging (P = .004), laboratory tests (P = .005), boarding and nursing (P = .001), and radiology (P = .002). More patients in the ST group required intubation for more than 72 hours (P = .019); however, there were no differences in morbidity or long-term survival (P = .334). A higher proportion of MI patients were discharged home with no nursing services (P = .018), and a higher proportion of ST patients required readmission within 1 year (P = .023). There were no differences in freedom from reoperation between groups (P = .574).
  
  
  CONCLUSIONS
  With equivalent efficacy across a range of measures and lower costs compared with ST, MIMVS represents a cost-saving strategy for MVS.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.forename: Rachel
authors.initials: R
authors.lastname: Easterwood
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Kimberly N
authors.initials: KN
authors.lastname: Hong
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000191:economics / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000191:economics / Q000601:surgery; D011183:Postoperative Complications; D056346:Sternotomy / Q000191:economics* / Q000379:methods; D013908:Thoracotomy / Q000191:economics