In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Transcatheter aortic valve replacement (TAVR) has become widely available across the United States; however, national trends have not been evaluated by hospital teaching status. Hypothesis: There will be no differences in outcomes between teaching hospitals (TH) versus non teaching hospitals. Methods: This was an observational study of patients undergoing TAVR from 2012-2017, utilizing the Nationwide Readmissions Database with appropriate trend weights to generate national estimates. Codes from the International Classification of Diseases were used to identify patients with a primary procedure code for TAVR. TAVRs were stratified by hospital teaching status, while in-hospital mortality, complications, costs, and 30- and 90-day readmissions were compared between the groups. Results: During the study’s timeframe, 123,557 patients underwent TAVR, of which 90% occurred at a TH. The number of TAVRs increased by 744% from 2012 to 2017 (Cochrane-Armitage test, p 〈 0.001), with a larger increase for non-TH. Median age [IQR] was 82.0 [76.0-87.0] and 46.2% were women. Patients undergoing TAVR at a teaching hospital were more likely to have diabetes, dyslipidemia, hypertension, coronary artery disease, congestive heart failure, peripheral vascular disease, and cerebrovascular disease. In-hospital mortality was higher for patients undergoing TAVR at a TH (2.6% vs. 2.2%, p 〈 0.001). After TAVR, there was more stroke (1.5% vs. 0.9%), acute kidney injury (14.6% vs. 11.3%), and myocardial infarction (4.2% vs. 2.8%) in the TH group. TAVR at a TH was associated with higher total cost of care during their index admission (47.9 [37.5-61.9] vs. 44.3 [34.7-58.7] x $1000) and longer length of hospital stay (4.0 [2.0-7.0] vs. 3.0 [2.0-6.0] days). Moreover, patients undergoing TAVR at a TH were more likely to have been discharged to an intermediate care facility or home health care (50.0% vs. 40.9%). 30-day readmissions were higher for the TH group (18.7% vs. 18.0%), while 90-day readmissions were similar across each group (28.4% for the entire cohort). Conclusions: While patients undergoing TAVR at a teaching hospital had more comorbidities, they also had higher in-hospital mortality, more postoperative complications, and greater healthcare costs.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.12911
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
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