Abstract 17798: Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database
Introduction: Unplanned hospitalizations after cardiac procedures occur frequently and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited.
Objective: To determine the incidence, predictors, causes, and costs of 30-day all-cause readmissions after TAVR in a real-world population of patients in the United States.
Methods: Patients undergoing TAVR (ICD-9-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. The incidence, predictors, primary diagnoses, and costs of 30-day readmissions were analyzed. Cox proportional hazards regression was used to identify independent predictors of 30-day readmission.
Results: Of 12,221 TAVR patients, 2,181 (17.8%) were readmitted within 30 days (median time: 10 days; interquartile range [IQR]: 4-18 days). Age ≥85 years, chronic kidney disease, chronic lung disease, transapical TAVR, acute kidney injury (AKI), AKI requiring dialysis, and length of stay >5 days during index hospitalization were independent predictors of 30-day readmission (Table 1). Readmissions were due to non-cardiac causes in 61.6% of cases and due to cardiac causes in 38.4% of cases. Respiratory (14.5%), infections (13.0%), bleeding (7.2%), and peripheral vascular disease (4.2%) were the most common non-cardiac causes, whereas heart failure (21.0%) and arrhythmias (6.5%) were the most common cardiac causes of readmission. Median length of stay and hospital cost of readmissions was 4 days (IQR: 2-7 days) and $8,248 (IQR: $5,226-15,875), respectively.
Conclusion: Thirty-day readmissions after TAVR are frequent and are related to baseline co-morbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
Author Disclosures: D. Kolte: None. S. Khera: None. M. Sardar: None. N. Gheewala: None. T. Gupta: None. S. Chatterjee: None. A. Goldsweig: None. W.S. Aronow: None. G.C. Fonarow: Other; Significant; Serves as Vice Chair of the ACC/AHA Task Force on Performance Measures. D.L. Bhatt: Research Grant; Significant; Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company. A.B. Greenbaum: None. P.C. Gordon: None. B.L. Sharaf: None. J.D. Abbott: None.
- © 2016 by American Heart Association, Inc.