Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.

Title

Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.

Creator

Khera S; Kolte D; Deo VS; Kalra A; Gupta T; Abbott JD; Kleiman NS; Bhatt DL; Fonarow GC; Khalique OK; Kodali S; Leon MB; Elmariah S

Publisher

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

Date

2019
2019-06-20

Description

AIMS: Patients undergoing transcatheter aortic valve replacement (TAVR) possess a higher risk of recurrent healthcare resource utilisation due to multiple comorbidities, frailty, and advanced age. We sought to devise a simple tool to identify TAVR patients at increased risk of 30-day readmission. METHODS AND RESULTS: We used the Nationwide Readmissions Database from January 2013 to September 2015. Complex survey methods and hierarchical regression in R were implemented to create a prediction tool to determine probability of 30-day readmission. Boot-strapped internal validation and cross-validation were performed to assess model accuracy. External validation was performed using a single-centre data set. Of 39,305 patients who underwent endovascular TAVR, 6,380 (16.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: chronic kidney disease, end-stage renal disease on dialysis (ESRD), anaemia, chronic lung disease, chronic liver disease, atrial fibrillation, length of stay, acute kidney injury, and discharge disposition. ESRD (OR 2.11, 95% CI: 1.7-2.63), length of stay ≥5 days (OR 1.64, 95% CI: 1.50-1.79), and short-term hospital discharge disposition (OR 1.81, 95% CI: 1.2-2.7) were the strongest predictors. The c-statistic of the prediction model was 0.63. The c-statistic in the external validation cohort was 0.69. On internal calibration, the tool was extremely accurate in predicting readmissions up to 25%. CONCLUSIONS: A simple and easy-to-use risk prediction tool utilising standard clinical parameters identifies TAVR patients at increased risk of 30-day readmission. The tool may consequently inform hospital discharge planning, optimise transitions of care, and reduce resource utilisation.

Subject

Humans; Treatment Outcome; Risk Factors; Time Factors; Aortic Valve; Patient Readmission; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement

Identifier

PMID: 30803938

Rights

Copyright © 2019. Published by Elsevier Inc.

Format

journalArticle

Search for Full-text

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Pages

155-163

Issue

2

Volume

15

ISSN

1969-6213 1774-024X

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Internal Medicine

Update Year & Number

June2020SubmittedList

Affiliated Hospital

Cleveland Clinic Akron General Hospital

Citation

Khera S; Kolte D; Deo VS; Kalra A; Gupta T; Abbott JD; Kleiman NS; Bhatt DL; Fonarow GC; Khalique OK; Kodali S; Leon MB; Elmariah S, “Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.,” NEOMED Bibliography Database, accessed June 18, 2021, https://neomed.omeka.net/items/show/11178.

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