Abstract 289: Factors Associated with Costs, Resource Utilization, and Mortality in Bentall Procedures

Abstract

Purpose: Studies investigating factors associated with procedure costs and resource utilization in Bentall procedures are rare, and the implications of operating room (OR) efficiencies on procedural outcomes for these complex and time consuming cardiac valve replacement procedures are unknown. The objective of this study was to use real world evidence to identify factors associated with inpatient mortality, overall length of stay (LOS), and total costs during an index hospitalization for a Bentall procedure. Methods: Eligible Bentall cases were identified in the Premier hospital database using a combination of ICD-9 and ICD-10 procedure codes for surgical aortic valve replacement (SAVR) and a text-mine of charge master billing files to identify the simultaneous use of an aortic conduit during the SAVR procedure. Multivariable regression models were estimated for LOS, mortality, and total index hospitalization costs. Each model was adjusted for patient demographics, comorbid conditions (as defined by Elixhauser Comorbidity Index), hospital characteristics, admission type (elective, urgent, or emergent), and operating room time (15 minute increments). Results: A total of 417 patients underwent a Bentall procedure between October 2014 and September 2017. Patients were primarily male (83%), Caucasian (80%), and married (63%), with a mean age of 57 years. Patients received more tissue valves (57%) and the majority of cases were elective procedures (61%) with a mean OR time of 440 minutes. Urgent and emergent procedures had longer mean operating room times, 60 minutes and 82 minutes respectively, and were significantly associated with increased hospital length of stay (2.16 days; p=0.0229, 3.03 days; p=0.0026). The analysis also found that a 15 minute increment of OR time was significantly associated with increased length of stay (1/4 day; p<0.0001), mortality (OR 1.07; p=0.021), and total hospitalization costs ($1,592; p<0.0001). Conclusions: Increased OR efficiencies are relevant to hospitals looking to improve outcomes, costs, and resource utilization associated with lengthy Bentall procedures, especially in urgent and emergent cases.