National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016.
National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016.
- 2021
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has evolved toward a minimalist approach, resulting in shorter hospital stays. Real-world trends of next-day discharge (NDD) TAVR are unknown. This study aimed to evaluate underlying trends and readmissions of NDD-TAVR. CONCLUSIONS: The percentage of NDD-TAVR increased over the years; however, readmission rates remained the same, with a higher rate of conduction abnormality-related hospitalizations in 2016. Careful discharge planning that includes identification of baseline factors that predict readmission and knowledge of etiologies may further prevent 30-day readmissions. Copyright (c) 2020. Published by Elsevier Inc. METHODS: This study was derived from the Nationwide Readmissions Database (NRD) from 2012 to 2016. International Classification of Diseases, Ninth and Tenth revisions, codes were used to identify patients. Any discharge within 1day of admission was identified as NDD. NDD-TAVR trends over the years were analyzed, and any admissions within 30days were considered readmissions. A hierarchical logistic regression model was used to identify predictors of readmission. RESULTS: Of 49,742 TAVR procedures, 3104 were NDD. The percentage of NDD-TAVR increased from 1.5% (46/3051) in 2012 to 12.2% (2393/19,613) in 2016. However, the 30-day readmission rate remained the same over the years (8.6%). The patients' mean age was 80.3+/-8.4years. Major readmission causes were heart-failure exacerbation (16%), infections (9%), and procedural complications (8%). In 2016, there were significantly higher late conduction disorder and gastrointestinal bleeding readmission rates than in 2012-2015. Significant predictors of readmission were anemia, baseline conduction disease, cardiac arrhythmias, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic disorders, and discharge to facility.
English
0002-8703
10.1016/j.ahj.2020.08.015 [doi] S0002-8703(20)30339-2 [pii]
*Patient Discharge/sn [Statistics & Numerical Data]
*Patient Readmission/sn [Statistics & Numerical Data]
*Transcatheter Aortic Valve Replacement/sn [Statistics & Numerical Data]
Aged, 80 and over
Anemia/ep [Epidemiology]
Arrhythmias, Cardiac/ep [Epidemiology]
Databases, Factual/sn [Statistics & Numerical Data]
Disease Progression
Female
Gastrointestinal Hemorrhage/ep [Epidemiology]
Heart Conduction System
Heart Failure/ep [Epidemiology]
Humans
Infections/ep [Epidemiology]
Logistic Models
Male
Patient Discharge/td [Trends]
Patient Readmission/td [Trends]
Postoperative Complications/ep [Epidemiology]
Pulmonary Disease, Chronic Obstructive/ep [Epidemiology]
Renal Insufficiency, Chronic/ep [Epidemiology]
Time Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Transcatheter Aortic Valve Replacement/td [Trends]
United States
MedStar Heart & Vascular Institute
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has evolved toward a minimalist approach, resulting in shorter hospital stays. Real-world trends of next-day discharge (NDD) TAVR are unknown. This study aimed to evaluate underlying trends and readmissions of NDD-TAVR. CONCLUSIONS: The percentage of NDD-TAVR increased over the years; however, readmission rates remained the same, with a higher rate of conduction abnormality-related hospitalizations in 2016. Careful discharge planning that includes identification of baseline factors that predict readmission and knowledge of etiologies may further prevent 30-day readmissions. Copyright (c) 2020. Published by Elsevier Inc. METHODS: This study was derived from the Nationwide Readmissions Database (NRD) from 2012 to 2016. International Classification of Diseases, Ninth and Tenth revisions, codes were used to identify patients. Any discharge within 1day of admission was identified as NDD. NDD-TAVR trends over the years were analyzed, and any admissions within 30days were considered readmissions. A hierarchical logistic regression model was used to identify predictors of readmission. RESULTS: Of 49,742 TAVR procedures, 3104 were NDD. The percentage of NDD-TAVR increased from 1.5% (46/3051) in 2012 to 12.2% (2393/19,613) in 2016. However, the 30-day readmission rate remained the same over the years (8.6%). The patients' mean age was 80.3+/-8.4years. Major readmission causes were heart-failure exacerbation (16%), infections (9%), and procedural complications (8%). In 2016, there were significantly higher late conduction disorder and gastrointestinal bleeding readmission rates than in 2012-2015. Significant predictors of readmission were anemia, baseline conduction disease, cardiac arrhythmias, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic disorders, and discharge to facility.
English
0002-8703
10.1016/j.ahj.2020.08.015 [doi] S0002-8703(20)30339-2 [pii]
*Patient Discharge/sn [Statistics & Numerical Data]
*Patient Readmission/sn [Statistics & Numerical Data]
*Transcatheter Aortic Valve Replacement/sn [Statistics & Numerical Data]
Aged, 80 and over
Anemia/ep [Epidemiology]
Arrhythmias, Cardiac/ep [Epidemiology]
Databases, Factual/sn [Statistics & Numerical Data]
Disease Progression
Female
Gastrointestinal Hemorrhage/ep [Epidemiology]
Heart Conduction System
Heart Failure/ep [Epidemiology]
Humans
Infections/ep [Epidemiology]
Logistic Models
Male
Patient Discharge/td [Trends]
Patient Readmission/td [Trends]
Postoperative Complications/ep [Epidemiology]
Pulmonary Disease, Chronic Obstructive/ep [Epidemiology]
Renal Insufficiency, Chronic/ep [Epidemiology]
Time Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Transcatheter Aortic Valve Replacement/td [Trends]
United States
MedStar Heart & Vascular Institute
Journal Article