Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.

Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.

Kolte Dhaval; Khera Sahil; Sardar M Rizwan; Gheewala Neil; Gupta Tanush; Chatterjee Saurav; Goldsweig Andrew; Aronow Wilbert S; Fonarow Gregg C; Bhatt Deepak L; Greenbaum Adam B; Gordon Paul C; Sharaf Barry; Abbott J Dawn

Circulation. Cardiovascular interventions

2017

2017-01

BACKGROUND: Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS: Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay \textgreater5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), \textgreater4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS: Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.

*aortic stenosis; *costs and cost analysis; *length of stay; *Patient Readmission/economics; *readmission; *rehospitalization; *transcatheter aortic valve implantation; *transcatheter aortic valve replacement; 80 and over; Aged; Aortic Valve Stenosis/diagnosis/economics/*surgery; Comorbidity; Databases; Factual; Female; Hospital Costs; Humans; Length of Stay; Male; Patient Discharge; Postoperative Complications/etiology; Risk Factors; Skilled Nursing Facilities; Time Factors; Transcatheter Aortic Valve Replacement/*adverse effects/economics; Treatment Outcome; United States

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