title: Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: a multi-institution analysis of 'real world' data.
abstract: BACKGROUND
  Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.
  
  
  METHODS
  The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.
  
  
  RESULTS
  AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n = 1572) and by aStern (n = 3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p < 0.01), teaching hospitals (66% vs 58%; p < 0.01) and larger hospitals (47% vs 30%; p < 0.01). There was significantly less blood product cost associated with RAT ($1381 vs $1912; p < 0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern ($38,769 vs $42,656; p < 0.01).
  
  
  CONCLUSIONS
  Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.
authors.affiliation: Saint Thomas Heart , Nashville, TN , USA.
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: John R
authors.initials: JR
authors.lastname: Mehall
authors.forename: Matt
authors.initials: M
authors.lastname: Moore
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
authors.forename: Alison F
authors.initials: AF
authors.lastname: Ward
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004469:Economics, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D056346:Sternotomy / Q000191:economics*; D013908:Thoracotomy / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: Aortic valve; Cost savings; Minimally invasive surgery; Outcomes