Author + information
- Sidakpal Panaich1,
- Shilpkumar Arora2,
- Nilay Patel3,
- Smit Patel4,
- Harshil Shah5,
- Chirag Savani6,
- Kriti Narwal7,
- Kosha Thakore8,
- Aditi Amin8,
- Sopan Lahewala9,
- Nileshkumar Patel10,
- Ekta Aneja11,
- Abhishek Deshmukh12 and
- Apurva Badheka13
- 1Borgess Medical Center, Kalamazoo, Minnesota, United States
- 2Mount Sinai St. Luke's Roosevelt, New York, New York, United States
- 3Saint Peter's University Hospital, New Brunswick, New Jersey, United States
- 4Tulane University, New Orleans, Louisiana, United States
- 5Detroit Medical Center, Detroit, Michigan, United States
- 6New York Medical College, Vahalla, New York, United States
- 7Lucila Medical PC-Family Medicine, St. Joseph's Hospital, Paterson, New Jersey, United States
- 8New York Medical College, Valhalla, New York, United States
- 9Jersey City Medical Center, Jersey City, New Jersey, United States
- 10University of Miami, Miami, Florida, United States
- 11St Barnabas Hospital, Bronx, New York, United States
- 12Mayo Clinic, Rochester, Minnesota, United States
- 13The Everett Clinic, Everett, Washington, United States
There is sparse data on the predictors of readmission following Transcatheter aortic valve replacement (TAVR).
The study cohort was derived from the National Readmission Data (NRD) 2013, a subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). TAVR was identified by ICD 9 CM(35.05, 35.06) codes. Appropriate ICD 9 codes were used to identify vasopressor, percutaneous coronary intervention (PCI), Hemodynamic support (HDS) and blood transfusion (BT). The co-primary outcomes were 30-day readmissions and in-hospital mortality during primary admission and readmission.
Our analysis included 5702 (weighted n= 12,703) TAVR procedures. 1215 patients were readmitted (weighted n=2757) within 30 days during the study year. Significant predictors of readmission included trans-apical access (OR, 95% CI, p-value) (1.23, 1.10 - 1.38, <0.01), diabetes (1.18, 1.06 - 1.32, p 0.004), chronic lung disease (1.32, 1.18 - 1.47, <0.01), renal failure (1.43, 1.24 - 1.65, <0.01), patients discharged to facilities (1.28, 1.14-1.43, <0.01) and those who had lengthier hospital stays during primary admission (LOS >10 days: 3.06, 2.22 - 4.22, <0.01). Female sex (1.39, 1.16 - 1.68, <0.01), BT (1.88, 1.55 - 2.29, <0.01), use of vasopressors (3.63, 2.50 - 5.28, <0.01), HDS (6.39, 5.20 - 7.85, <0.01) as well PCI (1.89, 1.30-2.74, 0.001) during primary admission were significant predictors of in-hospital mortality. Age (1.04, 1.01 - 1.08, 0.04) and transapical access (1.76, 1.07 - 2.91, 0.02) were significant predictors of in-hospital mortality during readmission.
Patients who underwent transapical TAVR and those with slower in-hospital recovery and comorbidities like chronic lung disease and renal failure are more likely to be readmitted to the hospital. Transapical access was also a predictor of inhospital mortality at readmission.
STRUCTURAL: Valvular Disease: Aortic