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The role of gender on in hospital outcomes after transcatheter aortic valve replacement (TAVR) has been poorly investigated, mostly limited to single center studies or systematic reviews/meta analysis and lacks nationally representative US based data. Therefore, we investigated distinct gender based risk profiles and in-hospital outcomes.
We analyzed data from HCUP’s Nationwide Inpatient Sample database from 2012-2014 for ICD-9-CM procedural codes 35.05 and 35.06 for TAVR using SAS. Chi-squared and Student’s t-test were used for univariate analysis of categorical variables and continuous variables respectively. Logistic regression analysis using PROC Surveylogistic was used for multivariable analysis for outcome of in hospital mortality while linear regression using PROC Surveyreg for outcomes of length of stay and cost of care.
41015 (weighted) procedures from 2012 to 2014 were included in our analysis (mean age 81.12 years, 81.3% White). 47.69% of these were female patients. Compared to male, female group was older (mean 81.72 years vs 80.57 years, p<.0001) with significant differences in distribution of comorbidities (Table 1a). In-patient mortality (4.88% vs 3.64%, p<0.0001), and length of stay were higher in female group on univariate analysis (8.34 days vs 7.7 days, p<0.0001) but difference in cost of care was not statistically significant ($59,178 vs $57,935, p=0.076). After adjusting for confounders, female gender was an independent predictor of higher odds of in-hospital mortality (odds ratio 1.4, CI 1.11-1.70, p<0.0001), longer LOS and higher cost of care.
Women compared to men undergoing TAVR have significantly different risk profile and are associated with higher in-hospital mortality, longer hospital stay and higher cost of care. Further randomized controlled studies confirming these observational findings are warranted and in turn may point to new areas of focus to continue ongoing improvement in procedural outcomes.
STRUCTURAL: Valvular Disease: Aortic