TY - JOUR
T1 - Does Urgent or Emergent Status Influence Choice in Mitral Valve Operations? An Analysis of Outcomes From the Virginia Cardiac Surgery Quality Initiative
AU - LaPar, Damien J.
AU - Hennessy, Sara
AU - Fonner, Eddie
AU - Kern, John A.
AU - Kron, Irving L.
AU - Ailawadi, Gorav
N1 - Funding Information:
We would like to thank George J. Stukenborg, PhD, of the University of Virginia Department of Public Health Sciences for his statistical collaboration in this study. This research was funded by the National Institutes of Health, National Heart, Lung, and Blood Institute T32 Training Grant HL007849 (D.L., S.H.) and TSFRE Research Grant (G.A.).
PY - 2010/7
Y1 - 2010/7
N2 - Background: Urgent or emergent status is often associated with increased risk among cardiac operations. The objective of this study was to analyze outcomes and cost differences in patients undergoing elective versus urgent or emergent mitral valve replacement (MVR) and repair operations. Methods: From 2003 to 2008, 1,477 patients underwent isolated, primary mitral valve (MV) operations at 11 different centers in the Commonwealth of Virginia. Patients were stratified into four groups: elective MVR (n = 419), elective MV repair (n = 674), urgent or emergent MVR (n = 261) and urgent or emergent MV repair (n = 123). Preoperative risk, operative features, outcomes, and total costs were evaluated. Results: Mitral valve replacement patients had more risk factors, including advanced age. Female sex and severe mitral regurgitation were more common among MV repairs. Mitral valve replacement incurred higher operative mortality (5.2% versus 1.2%; p < 0.001), more major complications (20.6% versus 6.5%; p < 0.001), longer postoperative (10.8 days versus 6.2 days; p < 0.001) and intensive care unit (117.7 hours versus 51.4 hours; p < 0.001) duration, and greater total costs ($45,166 versus $26,229; p < 0.001) compared with MV repair operations. Postoperative length of stay was longer for elective MVR patients compared with elective MV repair patients (p < 0.001) as well as for urgent or emergent MVR patients compared with urgent or emergent MV repair patients (p = 0.001). Total hospital costs were also higher for both elective MVR (p < 0.001) and urgent or emergent MVR (p < 0.001) compared with elective MV repair and urgent or emergent MV repair. Risk-adjusted operative mortality (odds ratio, 11.4; p < 0.001) and major complication rates (odds ratio, 7.6; p < 0.001) were highest for urgent or emergent MVR. Conclusions: Mitral valve repair is associated with lower morbidity, mortality, and total costs compared with MVR. For urgent or emergent operations, the improved outcomes with mitral repair versus replacement are even more profound.
AB - Background: Urgent or emergent status is often associated with increased risk among cardiac operations. The objective of this study was to analyze outcomes and cost differences in patients undergoing elective versus urgent or emergent mitral valve replacement (MVR) and repair operations. Methods: From 2003 to 2008, 1,477 patients underwent isolated, primary mitral valve (MV) operations at 11 different centers in the Commonwealth of Virginia. Patients were stratified into four groups: elective MVR (n = 419), elective MV repair (n = 674), urgent or emergent MVR (n = 261) and urgent or emergent MV repair (n = 123). Preoperative risk, operative features, outcomes, and total costs were evaluated. Results: Mitral valve replacement patients had more risk factors, including advanced age. Female sex and severe mitral regurgitation were more common among MV repairs. Mitral valve replacement incurred higher operative mortality (5.2% versus 1.2%; p < 0.001), more major complications (20.6% versus 6.5%; p < 0.001), longer postoperative (10.8 days versus 6.2 days; p < 0.001) and intensive care unit (117.7 hours versus 51.4 hours; p < 0.001) duration, and greater total costs ($45,166 versus $26,229; p < 0.001) compared with MV repair operations. Postoperative length of stay was longer for elective MVR patients compared with elective MV repair patients (p < 0.001) as well as for urgent or emergent MVR patients compared with urgent or emergent MV repair patients (p = 0.001). Total hospital costs were also higher for both elective MVR (p < 0.001) and urgent or emergent MVR (p < 0.001) compared with elective MV repair and urgent or emergent MV repair. Risk-adjusted operative mortality (odds ratio, 11.4; p < 0.001) and major complication rates (odds ratio, 7.6; p < 0.001) were highest for urgent or emergent MVR. Conclusions: Mitral valve repair is associated with lower morbidity, mortality, and total costs compared with MVR. For urgent or emergent operations, the improved outcomes with mitral repair versus replacement are even more profound.
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U2 - 10.1016/j.athoracsur.2010.03.044
DO - 10.1016/j.athoracsur.2010.03.044
M3 - Article
C2 - 20609766
AN - SCOPUS:77953622733
SN - 0003-4975
VL - 90
SP - 153
EP - 160
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -