PMID- 33068544 OWN - NLM STAT- MEDLINE DCOM- 20210802 LR - 20210802 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 112 IP - 1 DP - 2021 Jul TI - Cost Analysis of Minimally Invasive Mitral Valve Surgery in the UK National Health Service. PG - 124-131 LID - S0003-4975(20)31685-4 [pii] LID - 10.1016/j.athoracsur.2020.08.020 [doi] AB - BACKGROUND: In the UK National Health Service, finite resources make the adoption of minimally invasive (MI) mitral valve surgery challenging unless greater operative costs (vs sternotomy [ST]) are balanced by postoperative savings. This study examined whether the cost analysis now became unfavorable. METHODS: All patients (n = 380) undergoing isolated mitral valve surgery with or without a maze procedure over a 3-year period by either MI or ST approaches were included. Propensity matching (2 cohorts, 1:1 matched;, n = 75 per group) and multivariable regression were used to assess for the effect on cost. Cost data were prospectively collected from Service Line Reporting and reported in Sterling ( pound) as median (interquartile range [IQR]). RESULTS: Matched data revealed that total hospital costs were equivalent (MI vs ST, pound16,672 [IQR, pound15,044, pound20,611] vs pound15,875 [IQR, pound12,281, pound20,687]; P .33). Three of 15 costing pools were significantly different: operative costs were higher for the MI group (MI vs ST, pound7458 [IQR, pound6738, pound8286] vs pound5596 iIQR, pound4204, pound6992]; P < .001), whereas ward costs (boarding, nursing) (MI vs ST, pound1464 [IQR, pound1146, pound1864] vs pound1733 [IQR, pound1403, pound2445] P = .006) and pharmacy services (MI vs ST, pound187 [IQR, pound140, pound239] vs pound244 [IQR, pound179, pound375] P < .001) were lower for the MI group. Hospital stay was shorter in the MI group (MI vs ST, 6 days [IQR, 5, 8 days] vs 8 days [IQR, 6, 11 days]; P < .001). Multivariable regression produced similar findings. CONCLUSIONS: There was no difference in overall hospital cost between MI and ST mitral valve surgery: higher operative costs of MI surgery were offset by lower postoperative costs, with a 2-day shorter hospital stay. CI - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Perin, Giordano AU - Perin G AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. FAU - Shaw, Matthew AU - Shaw M AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. FAU - Toolan, Caroline AU - Toolan C AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. FAU - Palmer, Kenneth AU - Palmer K AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. FAU - Al-Rawi, Omar AU - Al-Rawi O AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. FAU - Modi, Paul AU - Modi P AD - Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: paul.modi@nhs.net. LA - eng PT - Journal Article DEP - 20201014 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Aged MH - Cardiac Surgical Procedures/*economics/methods MH - Costs and Cost Analysis MH - Female MH - Heart Valve Diseases/economics/*surgery MH - Hospital Costs/*trends MH - Humans MH - Male MH - Middle Aged MH - Minimally Invasive Surgical Procedures/*economics MH - Mitral Valve/*surgery MH - Prospective Studies MH - United Kingdom EDAT- 2020/10/18 06:00 MHDA- 2021/08/03 06:00 CRDT- 2020/10/17 20:07 PHST- 2020/04/14 00:00 [received] PHST- 2020/07/04 00:00 [revised] PHST- 2020/08/06 00:00 [accepted] PHST- 2020/10/18 06:00 [pubmed] PHST- 2021/08/03 06:00 [medline] PHST- 2020/10/17 20:07 [entrez] AID - S0003-4975(20)31685-4 [pii] AID - 10.1016/j.athoracsur.2020.08.020 [doi] PST - ppublish SO - Ann Thorac Surg. 2021 Jul;112(1):124-131. doi: 10.1016/j.athoracsur.2020.08.020. Epub 2020 Oct 14.