Author + information
- Alexis Okoh1,
- Bruce Haik2,
- Nathan Kang2,
- Colleen Cassidy2,
- Chunguang Chen2,
- Marc Cohen3,
- Bruce Haik4 and
- Mark Russo2
- 1RWJ Barnabas Health Newark Beth Israel Medical Center, Newark, New Jersey, United States
- 2RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States
- 3Newark Beth Israel Medical Center, Newark, New Jersey, United States
- 4RWJBarnabas Health, Bedminster, New Jersey, United States
Recent advances in transcatheter aortic valve replacement (TAVR) have led to the adoption of the technology in patients with lower surgical risk. The present study aims to analyze direct costs associated with TAVR in patients with different pre-operative risks.
Data were drawn from a prospectively maintained TAVR database of a single-center institution. Clinical data were matched with hospital-billing data of all patients included in the study. Patients were divided into three groups based on the Society of Thoracic Surgeons- Predicted Risk of Mortality (STS-PROM) score. (< 4%(low risk (LR), 4-8% (Intermediate risk (IR), > 8% (high risk (HR), respectively. Operative outcomes, resource use, and procedure costs were compared among patient categories
A total of 569 patients including 212 HR, 246 IR and 111 LR were analyzed. Unadjusted mortality rates were (HR:5.2%; IR:2.4%; LR:3.6% (p =0.298) at 30-days, (HR:17.5%; IR:8.1%; LR:6.3% (p =0.002) at 1-year and (HR:24%; IR:15 %; LR:7.2% (p =0.001) at 2-years respectively. The incidence of post-operative acute renal failure was higher with increasing operative risk (HR:3.7%; IR:1.2%; LR:0% (p =0.017). Post-operative mean length of stay decreased from 6 days in the HR group to 4 days in the IR and LR groups (p<0.001). Post-operatively, HR patients were more likely not to be discharged home than IR and IR patients (HR:46% vs. IR:27% vs. LR:14%; p< 0.001). Direct mean procedure costs were significantly higher in the HR group than the IR and LR groups (HR: $56,880 vs. IR: $48,956 vs. LR: $48,814, p< 0.001) respectively.
TAVR patients with higher pre-operative risk scores reported higher procedure costs and resource utilization than their IR and LR counterparts. Compared to HR patients, IR and LR patients stayed shorter and experienced better mortality rates post-procedure.
STRUCTURAL: Valvular Disease: Aortic