Abstract 19138: Thirty-day Readmission Following Transcatheter Aortic Valve Replacement is Common, Most Often Associated With Heart Failure and Infection, and Consumes Substantial Resources
Introduction: Readmission within 30 days of hospitalization (30dRA) is increasingly used as a metric for quality of care. Transcatheter aortic valve replacement (TAVR) is also increasing, but 30dRA following TAVR is not well-understood.
Hypothesis: The purpose of this study is to define the incidence, etiology, and resource utilization of 30dRA following TAVR.
Methods: We used the ICD-9-CM code for TAVR (35.05) to identify patients who underwent TAVR and survived to discharge in 2012, in the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project’s State Independent Databases for 4 geographically distinct states: Florida, Massachusetts, New York, and Washington. The patients were divided into 2 groups: those with and without a 30dRA. Patients with a 30dRA for rehabilitation on the day of discharge were excluded. Approximately 8% of 30dRA were not captured because they occurred in the following year.
Results: The incidence of 30dRA following TAVR was 20.2% (244/1210). The most common principal diagnoses for readmission were heart failure (21%), infection (17%), bleeding (11%), and dysrhythmia (7%). A total of 4.2% of patients died during the 30dRA. More than 60% required skilled care following discharge, and only 20% had a routine discharge to home or self-care. The Centers for Medicare and Medicaid Services (CMS) were the primary payer for 93.4% of 30dRA following TAVR. The mean length of stay for a 30dRA was 7.0 +/- 6.6 days. The mean charges for a 30dRA were $61,657 +/- $73,000. On univariate analysis, the number of chronic comorbidities (9.9 +/- 2.8 vs. 9.3+/- 2.8; P=0.002), length of index hospitalization (10.3 +/- 7.4 vs. 8.9 +/- 6.9; P=0.01), and non-routine discharge (83.1% vs. 72.6% P<0.001) were associated with 30dRA. There was no significant difference in the mean age (83 years), gender makeup (50% female), racial makeup (19% non-White), and primary payer between patients who did and did not have a 30dRA.
Conclusions: More than one in five patients undergoing TAVR is readmitted within 30 days of the procedure, most commonly for heart failure and infection. Future research should be directed toward identifying patients at risk for post-TAVR heart failure and infection prior to discharge, to reduce 30dRA.
Author Disclosures: D.J. Lerner: None.
- © 2015 by American Heart Association, Inc.