Mortality, Length of Stay, and Cost Implications of Procedural Bleeding After Percutaneous Interventions Using Large-Bore Catheters.
Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity.



To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost.



This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016.



Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications.



Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95% CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95% CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95% CI, 1.52-1.59; P < .001).



Periprocedural bleeding was common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.
Cardiovascular Research Foundation, New York, New York2Sahlgrenska University Hospital, Gothenburg, Sweden.
Björn
B
Redfors
Division of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri.
Brendan M
BM
Watson
Cardiovascular Research Foundation, New York, New York.
Thomas
T
McAndrew
McGill University, Montréal, Québec, Canada.
Emilie
E
Palisaitis
Cardiovascular Research Foundation, New York, New York.
Dominic P
DP
Francese
Texas Heart Institute, Houston, Texas.
Mehdi
M
Razavi
Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey.
Jordan
J
Safirstein
Icahn School of Medicine at Mount Sinai, New York, New York.
Roxana
R
Mehran
Cardiovascular Research Foundation, New York, New York8New York-Presbyterian Hospital/Columbia University Medical Center, New York9Associate Editor, JAMA Cardiology.
Ajay J
AJ
Kirtane
Cardiovascular Research Foundation, New York, New York6Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey10Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
Philippe
P
Généreux
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D062906:Cardiac Catheters; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D057510:Endovascular Procedures; D005260:Female; D017048:Health Care Costs; D006353:Heart-Assist Devices; D006406:Hematoma / Q000191:economics / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000191:economics / Q000453:epidemiology*; D011379:Prognosis; D019919:Prosthesis Implantation; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D014481:United States / Q000453:epidemiology