Abstract T P300: Stroke after Aortic Valve Surgery Increases Billing and Length of Stay
Background and Purpose: Aortic valve disease is increasing in prevalence as the population ages. We previously presented a prospective cohort of patients undergoing open surgical aortic valve replacement (AVR) and established that stroke is a frequent complication. However, the impact of stroke on the cost and length of hospitalization is not well characterized.
Methods: We performed a prospective cohort study of patients ≥ 65 years old undergoing open surgical aortic valve replacement for moderate to severe calcific aortic stenosis at two hospitals in our health system. Subjects were evaluated by neurologists at post-operative days 1, 3, and 7. Hospital billing charges, length of stay in the intensive care unit (ICU), and total hospital length of stay were compared between patients with and without stroke using rank sum. Correlations between stroke severity and hospital billing charges, length of stay in the ICU, and total hospital length of stay were evaluated using Spearman correlation.
Results: Complete hospital billing and length of stay data were available for 174 subjects, mean age 76 (standard deviation 6) years, 35% female, 6% non-white. Clinical stroke occurred in 28 (16%), median National Institutes of Stroke Scale (NIHSS) 3, interquartile range (IQR) 1 - 13. In-hospital mortality occurred in 9 (5%). Stroke was associated with increased total hospital billing charges, median $281,012 (IQR $218,754 - $304,031) vs $209,807 (IQR $175,163 - $273,755) for those without stroke, p=0.003. Clinical stroke was also associated with increased length of stay in the ICU, median 3 days (IQR 2 - 5) vs 1 day (IQR 1 - 2), p =0.0006, and total length of stay, 12 days (IQR 9 - 15) vs 10 days (IQR 8 - 13), p=0.01. Clinical stroke severity based on NIHSS was moderately correlated with total hospital billing charges (rho=0.49, p<0.0001), length of stay in the ICU (rho=0.53, p<0.0001), and total hospital length of stay (rho=0.36, p<0.0001). Excluding patients who died in the hospital did not change any of the findings.
Conclusions: Clinical stroke complicating valve replacement is associated with increased hospital billing charges, length of stay in the intensive care unit, and total hospital length of stay, all related to stroke severity.
Author Disclosures: S.R. Messe: Research Grant; Significant; Glaxo Smith Kline, Study of Neuroprotection in High Risk Aortic Repair Surgery. Consultant/Advisory Board; Modest; Glaxo Smith Kline, Study of Neuroprotection in High Risk Aortic Repair Surgery. M.A. Acker: None. S.E. Kasner: Research Grant; Significant; WL Gore, Acorda, AstraZeneca, Biogen. Consultant/Advisory Board; Significant; Medtronic, Parexel, Novartis, GlaxoSmithKline, Boehringer Ingelhieim, Abbvie, Pfizer. M. Bilello: None. W.Y. Szeto: None. Y. Woo: None. J.E. Bavaria: None. M. Fanning: None. T. Giovannetti: None. T.F. Floyd: None.
- © 2014 by American Heart Association, Inc.