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Ten-year trends in heart valve replacement operations
V H Thourani1, W S Weintraub, J M Craver
1Department of Surgery, Emory Center for Outcomes Research, Emory University School of Medicine, Atlanta, Georgia, USA.
The Annals of Thoracic Surgery
|September 2, 2000
Summary
Despite patients aging and becoming sicker, heart valve replacement outcomes remained stable. Efforts successfully reduced hospital length of stay and costs for aortic and mitral valve replacements.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
Background:
- Growing concerns regarding the quality and cost-effectiveness of heart valve replacement procedures.
- Need to analyze patient profiles and trends in outcomes and resource utilization over time.
Purpose of the Study:
- To examine patient demographics and trends in outcomes and resource utilization for heart valve replacement over a decade.
- To assess the impact of changing patient characteristics on surgical results and hospital resource use.
Main Methods:
- Prospective collection of clinical and procedural data for 2,972 patients undergoing valve replacement from 1988-1997.
- Utilized a computerized database for standardized data entry by trained medical personnel.
Main Results:
- Patients undergoing aortic valve replacement (AVR), mitral valve replacement (MVR), or combined procedures were older and sicker over time.
- Procedural outcomes and in-hospital mortality for AVR remained constant.
- Length of stay and costs initially increased, then significantly decreased between 1992-1997 for both AVR and MVR, with an overall annual cost reduction of $785.
Conclusions:
- Heart valve replacement outcomes remained consistent from 1988-1997, despite a trend towards older and sicker patients.
- Significant reductions in length of stay and hospital costs were achieved, particularly after 1992.
- Hospital costs in 1997 returned to or fell below 1988 levels, demonstrating improved resource management.