title: Quantifying the incremental cost of complications associated with mitral valve surgery in the United States.
abstract: OBJECTIVE
  The goal of this study was to quantify the net increase in resource use associated with complications after isolated mitral valve surgery.
  
  
  METHODS
  Deidentified patient-level claims data on a random sample of mitral valve operations performed in the United States from January 1, 2006, to December 31, 2007, were obtained from the National Inpatient Sample (n = 16,788). Patients with major concomitant cardiac procedures were excluded from the analysis for a net sample size of 6297 patients. Risk-adjusted median total hospital costs and length of stay were analyzed by major complications, including pneumonia, sepsis, stroke, renal failure requiring hemodialysis, cardiac tamponade, myocardial infarction, gastrointestinal bleed, and venous thromboembolism.
  
  
  RESULTS
  There were a total of 1323 complication events that occurred in 1089 patients. The most common complication was pneumonia (n = 346, 5.5%), which was associated with a $29,692 increase in hospital costs and a 10.2-day increase in median length of stay (P < .001). The most costly complication was cardiac tamponade, which resulted in an increase in hospital cost of $56,547 and an increase in length of stay of 19.3 days (P < .001). There was a stepwise association between the hospital costs and length of stay and the number of complications per patient (P < .001). There was also a significant association between the discharge location and the occurrence of a complication, with 25% more patients who underwent routine home discharge when there were no complications (P < .001).
  
  
  CONCLUSIONS
  In patients undergoing isolated mitral valve surgery, postoperative complications were associated with significant increases in mortality, hospital costs, and length of stay, as well as with discharge location. With growing national attention to improving quality and containing costs, it is important to understand the nature and impact of complications on outcomes and costs.
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: John D
authors.initials: JD
authors.lastname: Burgener
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hong
authors.forename: Jai
authors.initials: J
authors.lastname: Raman
authors.forename: Shahab
authors.initials: S
authors.lastname: Akhter
authors.forename: Rachel
authors.initials: R
authors.lastname: Easterwood
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D005260:Female; D006349:Heart Valve Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D018803:Models, Economic; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States