title: Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings.
abstract: OBJECTIVE
  Small series of thoracotomy for mitral valve repair have demonstrated clinical benefit. This multi-institutional administrative database analysis compares outcomes of thoracotomy and sternotomy approaches for mitral repair.
  
  
  METHODS
  The Premier database was queried from 2007 to 2011 for mitral repair hospitalizations. Premier contains billing, cost, and coding data from more than 600 US hospitals, totaling 25 million discharges. Thoracotomy and sternotomy approaches were identified through expert rules; robotics were excluded. Propensity matching on baseline characteristics was performed. Regression analysis of surgical approach on outcomes and costs was modeled.
  
  
  RESULTS
  Expert rule analysis positively identified thoracotomy in 847 and sternotomy in 566. Propensity matching created 2 groups of 367. Mortalities were similar (thoracotomy 1.1% vs sternotomy 1.9%). Sepsis and other infections were significantly lower with thoracotomy (1.1% vs 4.4%). After adjustment for hospital differences, thoracotomy carried a 17.2% lower hospitalization cost (-$8289) with a 2-day stay reduction. Readmission rates were significantly lower with thoracotomy (26.2% vs 35.7% at 30 days and 31.6% vs 44.1% at 90 days). Thoracotomy was more common in southern and northeastern hospitals (63% vs 37% and 64% vs 36%, respectively), teaching hospitals (64% vs 36%) and larger hospitals (>600 beds, 78% vs 22%).
  
  
  CONCLUSIONS
  Relative to sternotomy, thoracotomy for mitral repairs provides similar mortality, less morbidity, fewer infections, shorter stay, and significant cost savings during primary admission. The markedly lower readmission rates for thoracotomy will translate into additional institutional cost savings when a penalty on hospitals begins under the Affordable Care Act's Hospital Readmissions Reduction Program.
authors.affiliation: NYU Langone Medical Center, New York, NY. Electronic address: eugene.grossi@nyumc.org.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.affiliation: Main Line Health Care, Wynnewood, Pa.
authors.forename: Scott
authors.initials: S
authors.lastname: Goldman
authors.affiliation: Northeast Georgia Medical Center, Gainesville, Ga.
authors.forename: J Alan
authors.initials: JA
authors.lastname: Wolfe
authors.affiliation: Penrose-St Francis Health Services, Colorado Springs, Colo.
authors.forename: John
authors.initials: J
authors.lastname: Mehall
authors.affiliation: TriHealth Heart Institute, Cincinnati, Ohio.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Smith
authors.affiliation: University of Virginia, Charlottesville, Va.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: New York Presbyterian-Weill Cornell Medical Center, New York, NY.
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
authors.affiliation: Edwards Lifesciences LLC, Irvine, Calif.
authors.forename: Matt
authors.initials: M
authors.lastname: Moore
authors.affiliation: NYU Langone Medical Center, New York, NY.
authors.forename: Alison
authors.initials: A
authors.lastname: Ward
authors.affiliation: S2 Statistical Solutions, Inc, Cincinnati, Ohio.
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D017046:Cost Savings; D005260:Female; D006349:Heart Valve Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D006742:Hospital Bed Capacity / Q000191:economics; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D018803:Models, Economic; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D057216:Propensity Score; D056346:Sternotomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States