title: Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge.
abstract: BACKGROUND
  There is a concerted push for adopting a minimalist strategy with emphasis on early hospital discharge for patients undergoing Transcatheter aortic valve implantation (TAVI). However, studies on discharge patterns and predictors of early discharge (≤3 days post-TAVI) are sparse, in the United States.
  
  
  METHODS
  We analyzed using Healthcare Utilization Project, Nationwide Inpatient Sample database, 2011-2012. A total of 7321 TAVI procedures were identified. We compared in-hospital outcomes between early and late discharge cohorts, and determined the predictors of early discharge. Correlation of costs and post-TAVI length of stay was also performed.
  
  
  RESULTS
  Early discharge rate post-TAVI was about 21% in the United States, in 2011-2012. Overall mean age was 81 years. In-hospital adverse outcomes post-TAVI were higher in late discharge cohort (P < 0.001). Mean length of stay post-TAVI (7.7 days vs 2.6 days) and costs ($208 752 vs $157 663) were significantly higher in late discharge than early discharge cohort. Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support, acute kidney injury were associated with significantly lower adjusted odds for early discharge. Transfemoral TAVI approach, prior aortic valvuloplasty, and procedure year 2012 were associated with significantly higher odds for early discharge. We observed positive correlation between costs of hospitalization and post-TAVI length of stay (R = 0.58; P < 0.001).
  
  
  CONCLUSIONS
  Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support devices, renal failure were associated with lower odds for early discharge. Transfemoral approach and prior aortic valvuloplasty increased the likelihood for early discharge. Post-TAVI length of stay was associated with significantly higher hospitalization costs.
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Sagar
authors.identifier: http://orcid.org/0000-0001-6298-0356
authors.initials: S
authors.lastname: Mallikethi-Reddy
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Akintoye
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Telila
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sudhakar
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Kavyashri
authors.initials: K
authors.lastname: Jagadeesh
authors.affiliation: Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Melvyn
authors.initials: M
authors.lastname: Rubenfire
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014481:United States
keywords: TAVI; early discharge