Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database

Dhaval Kolte; Sahil Khera; M. Rizwan Sardar; Neil Gheewala; Tanush Gupta; Saurav Chatterjee; Andrew Goldsweig; Wilbert S. Aronow; Gregg C. Fonarow; Deepak L. Bhatt; Adam B. Greenbaum; Paul C. Gordon; Barry Sharaf; J. Dawn Abbott

doi:10.1161/CIRCINTERVENTIONS.116.004472

Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database

Dhaval Kolte, Sahil Khera, M. Rizwan Sardar, Neil Gheewala, Tanush Gupta, Saurav Chatterjee, Andrew Goldsweig, Wilbert S. Aronow, Gregg C. Fonarow, Deepak L. Bhatt, Adam B. Greenbaum, Paul C. Gordon, Barry Sharaf, J. Dawn Abbott

Research output: Contribution to journal › Article › peer-review

131 Scopus citations

Abstract

Background - Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. Methods and Results - Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. Conclusions - Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, 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.

Original language	English (US)
Article number	e004472
Journal	Circulation: Cardiovascular Interventions
Volume	10
Issue number	1
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.116.004472
State	Published - Jan 1 2017
Externally published	Yes

Keywords

aortic stenosis
costs and cost analysis
length of stay
readmission
rehospitalization
transcatheter aortic valve implantation
transcatheter aortic valve replacement

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1161/CIRCINTERVENTIONS.116.004472

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Kolte, D., Khera, S., Sardar, M. R., Gheewala, N., Gupta, T., Chatterjee, S., Goldsweig, A., Aronow, W. S., Fonarow, G. C., Bhatt, D. L., Greenbaum, A. B., Gordon, P. C., Sharaf, B., & Abbott, J. D. (2017). Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database. Circulation: Cardiovascular Interventions, 10(1), Article e004472. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004472

Kolte, D, Khera, S, Sardar, MR, Gheewala, N, Gupta, T, Chatterjee, S, Goldsweig, A, Aronow, WS, Fonarow, GC, Bhatt, DL, Greenbaum, AB, Gordon, PC, Sharaf, B & Abbott, JD 2017, 'Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database', Circulation: Cardiovascular Interventions, vol. 10, no. 1, e004472. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004472

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title = "Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database",

abstract = "Background - Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. Methods and Results - Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. Conclusions - Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, 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.",

keywords = "aortic stenosis, costs and cost analysis, length of stay, readmission, rehospitalization, transcatheter aortic valve implantation, transcatheter aortic valve replacement",

author = "Dhaval Kolte and Sahil Khera and Sardar, {M. Rizwan} and Neil Gheewala and Tanush Gupta and Saurav Chatterjee and Andrew Goldsweig and Aronow, {Wilbert S.} and Fonarow, {Gregg C.} and Bhatt, {Deepak L.} and Greenbaum, {Adam B.} and Gordon, {Paul C.} and Barry Sharaf and Abbott, {J. Dawn}",

year = "2017",

month = jan,

day = "1",

doi = "10.1161/CIRCINTERVENTIONS.116.004472",

language = "English (US)",

volume = "10",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States

T2 - Insights from the Nationwide Readmissions Database

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Sardar, M. Rizwan

AU - Gheewala, Neil

AU - Gupta, Tanush

AU - Chatterjee, Saurav

AU - Goldsweig, Andrew

AU - Aronow, Wilbert S.

AU - Fonarow, Gregg C.

AU - Bhatt, Deepak L.

AU - Greenbaum, Adam B.

AU - Gordon, Paul C.

AU - Sharaf, Barry

AU - Abbott, J. Dawn

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background - Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. Methods and Results - Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. Conclusions - Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, 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.

AB - Background - Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. Methods and Results - Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. Conclusions - Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, 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.

KW - aortic stenosis

KW - costs and cost analysis

KW - length of stay

KW - readmission

KW - rehospitalization

KW - transcatheter aortic valve implantation

KW - transcatheter aortic valve replacement

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Thirty-Day Readmissions after Transcatheter Aortic Valve Replacement in the United States: Insights from the Nationwide Readmissions Database

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ASJC Scopus subject areas

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