Quantifying the incremental cost of complications associated with mitral valve surgery in the United States
ABSTRACT The goal of this study was to quantify the net increase in resource use associated with complications after isolated mitral valve surgery.
Deidentified patient-level claims data on a random sample of mitral valve operations performed in the United States from January 1, 2006, to December 31, 2007, were obtained from the National Inpatient Sample (n = 16,788). Patients with major concomitant cardiac procedures were excluded from the analysis for a net sample size of 6297 patients. Risk-adjusted median total hospital costs and length of stay were analyzed by major complications, including pneumonia, sepsis, stroke, renal failure requiring hemodialysis, cardiac tamponade, myocardial infarction, gastrointestinal bleed, and venous thromboembolism.
There were a total of 1323 complication events that occurred in 1089 patients. The most common complication was pneumonia (n = 346, 5.5%), which was associated with a $29,692 increase in hospital costs and a 10.2-day increase in median length of stay (P < .001). The most costly complication was cardiac tamponade, which resulted in an increase in hospital cost of $56,547 and an increase in length of stay of 19.3 days (P < .001). There was a stepwise association between the hospital costs and length of stay and the number of complications per patient (P < .001). There was also a significant association between the discharge location and the occurrence of a complication, with 25% more patients who underwent routine home discharge when there were no complications (P < .001).
In patients undergoing isolated mitral valve surgery, postoperative complications were associated with significant increases in mortality, hospital costs, and length of stay, as well as with discharge location. With growing national attention to improving quality and containing costs, it is important to understand the nature and impact of complications on outcomes and costs.
SourceAvailable from: Emiliano Votta[Show abstract] [Hide abstract]
ABSTRACT: Recent computational methods enabling patient-specific simulations of native and prosthetic heart valves are reviewed. Emphasis is placed on two critical components of such methods: (1) anatomically realistic finite element models for simulating the structural dynamics of heart valves; and (2) fluid structure interaction methods for simulating the performance of heart valves in a patient-specific beating left ventricle. It is shown that the significant progress achieved in both fronts paves the way toward clinically relevant computational models that can simulate the performance of a range of heart valves, native and prosthetic, in a patient-specific left heart environment. The significant algorithmic and model validation challenges that need to be tackled in the future to realize this goal are also discussed.Journal of Biomechanics 11/2012; 46(2). DOI:10.1016/j.jbiomech.2012.10.026 · 2.50 Impact Factor
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ABSTRACT: Objectives: Postoperative pulmonary complications are a burden for high-risk surgical patients with a risk of aspiration of subglottic secretions along the polyvinyl chloride cuff. The introduction of a polyurethane cuff diminishes secretion leakage with a decreased rate of pneumonia. The aim of the current analysis was to determine the time at which a polyurethane cuffed endotracheal tube might be advantageous to prevent aspiration in a setting of high-risk surgical patients. Methods: The present investigation is based on published data obtained in postoperative cardiac surgical patients undergoing operation from 2006 to 2007. Cuff pressure was kept between 20 and 26 cmH2O intraoperatively and in the intensive care unit. The current post hoc analysis determines (1) the discriminatory cutoff value of intubation duration for predicting postoperative pneumonia and (2) the potential factors associated with prolonged intubation. Results: Forty-three patients (32%) were diagnosed with early postoperative pneumonia. Receiver operating characteristics analysis revealed a cutoff value of 16.6 hours for the duration of mechanical ventilation to discriminate patients with postoperative pneumonia. A stepwise binary logistic regression analysis revealed that a polyvinyl chloride cuff was associated with a 10-fold increased risk for prolonged intubation. Conclusions: The current analyses provide evidence that among cardiac surgical patients, mechanical ventilation more than 16.6 hours is associated with an increased likelihood of postoperative pneumonia.Journal of Thoracic and Cardiovascular Surgery 07/2014; 148(4). DOI:10.1016/j.jtcvs.2014.05.085 · 3.99 Impact Factor
Journal of cardiothoracic and vascular anesthesia 12/2013; 28(3). DOI:10.1053/j.jvca.2013.08.006 · 1.48 Impact Factor