POSITIVE TREND: COST AND DAYS IN HOSPITAL DECLINE DESPITE SICKER PATIENTS UNDERGOING VALVE SURGERY

Over the past decade, costs associated with surgery to treat heart valve disease and days spent in the hospital have continued to decline; this in light of significantly sicker patients undergoing valve surgeries, reported Emory researchers at the 71st Scientific Sessions of the American Heart Association in November.

Researchers evaluated data from 2,972 patients who underwent heart valve surgery between 1988-97. Patients undergoing either aortic valve replacement, mitral valve replacement or both at Emory University Hospitals in 1997 compared with patients in 1989 were older (61 versus 59), were more likely to have high blood pressure (54 percent of patients versus 37 percent) and more likely to have undergone coronary artery bypass surgery (37 percent versus 26 percent). Despite this "riskier" patient population, hospital death rates remained constant over the 10-year interval.

In all categories of valve surgery, declines in cost and hospital stays were statistically significant. Cost of aortic valve replacement was an average of $21,439 in 1997 -- a $7,084 reduction from 1989 -- and patients stayed eight days in the hospital in 1997 versus 12.3 in 1989. Mitral valve replacement was an average of $21,280 per procedure in 1997 -- an $11,220 reduction from 1989 -- and patients stayed 8.1 rather than 13.2 days in the hospital. Patients undergoing the combined procedure in 1997 paid an average of $10,900 less in 1997 than in 1989, and remained in the hospital 10.1 rather than 17.9 days.

"Concern about costs and outcome of valve surgery have paralleled those for coronary bypass surgery (CABG)," Dr. Weintraub says. "Changes in care for patients having valve surgery has been similar to that for CABG. Whether these trends continue will be seen," he says.