title: Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy.
abstract: OBJECTIVE
  Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy.
  
  
  METHODS
  All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records.
  
  
  RESULTS
  Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups.
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address: pavan.atluri@uphs.upenn.edu.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stetson
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: George
authors.initials: G
authors.lastname: Hung
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Gaffey
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D006349:Heart Valve Diseases / Q000191:economics* / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D056346:Sternotomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
keywords: costs; health care economics; minimally invasive; mitral valve; outcomes