In-hospital resource utilization in surgical and transcatheter aortic valve replacement.
BACKGROUND
Little is known about preoperative predictors of resource utilization in the treatment of high-risk patients with severe symptomatic aortic valve stenosis. We report results from the prospective, medical-economic "TAVI Calculation of Costs Trial".


METHODS
In-hospital resource utilization was evaluated in 110 elderly patients (age ≥ 75 years) treated either with transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation (TAVI, N = 83), or surgical aortic valve replacement (AVR, N = 27). Overall, 22 patient-specific baseline parameters were tested for within-group prediction of resource use.


RESULTS
Baseline characteristics differed between groups and reflected the non-randomized, real-world allocation of treatment options. Overall procedural times were shortest for TAVI, intensive care unit (ICU) length of stay (LoS) was lowest for AVR. Length of total hospitalization since procedure (THsP) was lowest for TF-TAVI; 13.4 ± 11.4 days as compared to 15.7 ± 10.5 and 21.2 ± 15.4 days for AVR and TA-TAVI, respectively. For TAVI and AVR, EuroScore I remained the main predictor for prolonged THsP (p <0.01). Within the TAVI group, multivariate regression analyses showed that TA-TAVI was associated with a substantial increase in THsP (55 to 61 %, p <0.01). Additionally, preoperative aortic valve area (AVA) was identified as an independent predictor of prolonged THsP in TAVI patients, irrespective of risk scores (p <0.05).


CONCLUSIONS
Our results demonstrate significant heterogeneity in patients baseline characteristics dependent on treatment and corresponding differences in resource utilization. Prolonged ThsP is not only predicted by risk scores but also by baseline AVA, which might be useful in stratifying TAVI patients.


BACKGROUND
German Clinical Trial Register Nr. DRKS00000797.
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. jochen.reinoehl@universitaets-herzzentrum.de.
Jochen
J
Reinöhl
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. kaier@imbi.uni-freiburg.de.|Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg, Germany. kaier@imbi.uni-freiburg.de.
Klaus
K
Kaier
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. anja.gutmann.medizin@universitaets-herzzentrum.de.
Anja
A
Gutmann
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. stefan.sorg@universitaets-herzzentrum.de.
Stefan
S
Sorg
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. constantin.vonzurmuehlen@universitaets-herzzentrum.de.
Constantin
C
von Zur Mühlen
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. matthias.siepe@universitaets-herzzentrum.de.
Matthias
M
Siepe
Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany. hardy.baumbach@rbk.de.
Hardy
H
Baumbach
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. Martin.Moser@uniklinik-freiburg.de.
Martin
M
Moser
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. annette.geibel-zehender@uniklinik-freiburg.de.
Annette
A
Geibel
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. andreas.zirlik@uniklinik-freiburg.de.
Andreas
A
Zirlik
Department of Diagnostic Radiology, Medical Center-University of Freiburg, Freiburg, Germany. phil.blanke@gmail.com.
Philipp
P
Blanke
Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg, Germany. wv@imbi.uni-freiburg.de.
Werner
W
Vach
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. friedhelm.beyersdorf@universitaets-herzzentrum.de.
Friedhelm
F
Beyersdorf
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. christoph.bode@universitaets-herzzentrum.de.
Christoph
C
Bode
Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. manfred.zehender@universitaets-herzzentrum.de.
Manfred
M
Zehender
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement