अमूर्त
Evaluation of heart valve prosthesis implantations, infections and related extrapolated costs.
Claudia Schrimpf, Miriam Schaper, Julia Umminger, Saad Rustum, Christian Kuehn, Michaela Wilhelmi, Axel Haverich and Mathias Wilhelmi.
Background: Prosthetic heart valve implantations are standard in cardiac surgery. Transcatheter procedures gained popularity within the last decade for multi-morbid patients. However, approximately 5% of implants develop infections, causing a life-threatening event. We aimed to analyze if procedure-codes suffice to link implantation and infection, to dissect the impact of transcatheter valve implantations on infections and to calculate the financial burden valve infections cause. Methods: Nationwide data on heart valve implantations and infections between 2005 and 2012 were acquired through operation procedure and disease related ICD-10-GM codes. Oneway ANOVA analyzed infection prevalence in dependency from age. Contingency testing for consecutive years compared infected and non-infected implants. Pearson correlation of infections and 1) transcatheter 2) conventional and 3) minimal invasive valve implantations was performed. We analyzed costs for valve infections in our own institution in 2012 and extrapolated those nationwide. Results: Age (p<0.001) was a predictor for implantations (n=100,681), infections (n=3,224) and infections/implantations (p<0.05). Most cases could be observed in patients >65 years. Transcatheter procedures (p=0.007; r=0.851) and minimal invasive procedures in the elderly (p=0.009; r=0.836) were associated to infections. Surgical implantation was negatively correlated (p<0.0001; r=-0.9847). In 2012 we could identify 33,396.00€ as average treatment costs of an infected prosthesis at our institution, causing costs of 16,898,376.00€ nationwide. Conclusion: Prosthetic heart valve infections burden the health care system with over 16 million €/year. Transcatheter valve implantations were associated with infections, while conventional surgery showed negative correlation. Until now, it remains unclear if transcatheter methods will hold up to conventional results.