Etiologies and Predictors of 30-Day Readmission and In-Hospital Mortality During Primary and Readmission After Transcatheter Aortic Valve Implantation.
There are sparse data on the etiologies and predictors of readmission after transcatheter aortic valve implantation (TAVI). The study cohort was derived from the National Readmission Data 2013, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. TAVI was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The coprimary outcomes were 30-day readmissions and in-hospital mortality during primary admission and readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. Our analysis included 5,702 (weighted n = 12,703) TAVI procedures. About 1,215 patients were readmitted (weighted n = 2,757) within 30 days during the study year. Significant predictors of readmission included transapical access (OR, 95% CI, p value) (1.23, 1.10 to 1.38, <0.01), diabetes (1.18, 1.06 to 1.32, p 0.004), chronic lung disease (1.32, 1.18 to 1.47, <0.01), renal failure (1.43, 1.24 to 1.65, <0.01), patients discharged to facilities (1.28, 1.14 to 1.43, <0.01), and those who had lengthier hospital stays during primary admission (length of stay >10 days: 3.06, 2.22 to 4.22, <0.01). Female gender (1.39, 1.16 to 1.68, <0.01), blood transfusion (1.88, 1.55 to 2.29, <0.01), use of vasopressors (3.63, 2.50 to 5.28, <0.01), hemodynamic support (6.39, 5.20 to 7.85, <0.01) and percutaneous coronary intervention (1.89, 1.30 to 2.74, 0.01) during primary admission were significant predictors of in-hospital mortality. Age and transapical access were significant predictors of in-hospital mortality during readmission. In conclusion, heart failure, pneumonia, and bleeding complications are among important etiologies of readmission in patients after TAVI. Patients who underwent transapical TAVI and those with slower in-hospital recovery and co-morbidities such as chronic lung disease and renal failure are more likely to be readmitted to the hospital.
Cardiology Department, Borgess Medical Center, Kalamazoo, Michigan.
Sidakpal S
SS
Panaich
Internal Medicine Department, Mount Sinai St Luke's, Roosevelt Hospital, New York, New York.
Shilpkumar
S
Arora
Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
Nilay
N
Patel
Internal Medicine Department, Jersey City Medical Center, Jersey City, New Jersey.
Sopan
S
Lahewala
Cardiology Department, Borgess Medical Center, Kalamazoo, Michigan.
Yash
Y
Agrawal
Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
Nileshkumar J
NJ
Patel
Cardiology Department, Detroit Medical Center, Detroit, Michigan.
Harshil
H
Shah
Internal Medicine Department, Cleveland Clinic Florida, Weston, Florida.
Viralkumar
V
Patel
Cardiology Department, Mayo Clinic, Rochester, Minnesota.
Abhishek
A
Deshmukh
Cardiology Department, Detroit Medical Center, Detroit, Michigan.
Theodore
T
Schreiber
Cardiology Department, Detroit Medical Center, Detroit, Michigan.
Cindy L
CL
Grines
Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com.
Apurva O
AO
Badheka
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D014481:United States / Q000453:epidemiology