title: Is it safe to perform dental and cardiac valve surgeries concomitantly?
abstract: OBJECTIVE
  Conventionally, dental surgery and cardiac valve replacement surgery (VRS) have been performed separately. Disadvantages of this approach include increased anesthetic and infection risks and increased costs. The authors hypothesized dental surgeries performed immediately before VRS would have similar mortality and morbidity outcomes and significantly decreased costs compared with those performed independently of VRS.
  
  
  METHODS
  An institutional review board-approved retrospective study was completed comparing outcomes for 17 patients undergoing concomitant cardiac VRS and invasive dental procedures with outcomes for 16 patients undergoing similar procedures by a conventional approach.
  
  
  RESULTS
  The conventional group had a significant increase in ejection fraction (11% vs 6.7%; P < .05) and no difference in the incidence of prosthetic valve endocarditis or other cardiac complications. The concomitant group had longer overall operating room time (389 vs 328 min) but significantly shorter anesthesia time (428 vs 553 min) than the conventional group. Length of stay in the intensive care unit was similar (6.7 days) and overall hospital stays were shorter in the concomitant group (14.5 vs 18.2 days). Cost analysis showed the concomitant group's overall costs were significantly lower than those for the conventional group.
  
  
  CONCLUSIONS
  There was no significant difference in cardiac outcomes between the concomitant and conventional groups. In addition, each patient in the concomitant approach saved an average of $6,669. Thus, concomitant dental surgery and cardiac VRS may be considered a safe and cost-effective approach that may lead to decreases in overall health care costs.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, VA 23298-0566, USA.
authors.forename: Din
authors.initials: D
authors.lastname: Lam
authors.forename: Kevin
authors.initials: K
authors.lastname: Wright
authors.forename: Benjamin
authors.initials: B
authors.lastname: Archer
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012449:Safety; D014081:Tooth Extraction / Q000191:economics; D016896:Treatment Outcome