Journal article
Etiologies and Predictors of 30-Day Readmission and In-Hospital Mortality During Primary and Readmission After Transcatheter Aortic Valve Implantation
The American journal of cardiology, Vol.118(11), pp.1705-1711
12/01/2016
DOI: 10.1016/j.amjcard.2016.08.052
PMID: 27677388
Abstract
There are sparse data on the etiologies and predictors of readmission after transcatheter aortic valve implantation (TAVI). The study cohort was derived from the National Readmission Data 2013, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. TAVI was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The coprimary outcomes were 30-day readmissions and in-hospital mortality during primary admission and readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. Our analysis included 5,702 (weighted n = 12,703) TAVI procedures. About 1,215 patients were readmitted (weighted n = 2,757) within 30 days during the study year. Significant predictors of readmission included transapical access (OR, 95% CI, p value) (1.23, 1.10 to 1.38, <0.01), diabetes (1.18, 1.06 to 1.32, p 0.004), chronic lung disease (1.32, 1.18 to 1.47, <0.01), renal failure (1.43, 1.24 to 1.65, <0.01), patients discharged to facilities (1.28, 1.14 to 1.43, <0.01), and those who had lengthier hospital stays during primary admission (length of stay >10 days: 3.06, 2.22 to 4.22, <0.01). Female gender (1.39, 1.16 to 1.68, <0.01), blood transfusion (1.88, 1.55 to 2.29, <0.01), use of vasopressors (3.63, 2.50 to 5.28, <0.01), hemodynamic support (6.39, 5.20 to 7.85, <0.01) and percutaneous coronary intervention (1.89, 1.30 to 2.74, 0.01) during primary admission were significant predictors of in-hospital mortality. Age and transapical access were significant predictors of in-hospital mortality during readmission. In conclusion, heart failure, pneumonia, and bleeding complications are among important etiologies of readmission in patients after TAVI. Patients who underwent transapical TAVI and those with slower in-hospital recovery and co-morbidities such as chronic lung disease and renal failure are more likely to be readmitted to the hospital.
Details
- Title: Subtitle
- Etiologies and Predictors of 30-Day Readmission and In-Hospital Mortality During Primary and Readmission After Transcatheter Aortic Valve Implantation
- Creators
- Sidakpal S Panaich - Cardiology Department, Borgess Medical Center, Kalamazoo, MichiganShilpkumar Arora - Internal Medicine Department, Mount Sinai St Luke's, Roosevelt Hospital, New York, New YorkNilay Patel - Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New JerseySopan Lahewala - Internal Medicine Department, Jersey City Medical Center, Jersey City, New JerseyYash Agrawal - Cardiology Department, Borgess Medical Center, Kalamazoo, MichiganNileshkumar J Patel - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaHarshil Shah - Cardiology Department, Detroit Medical Center, Detroit, MichiganViralkumar Patel - Internal Medicine Department, Cleveland Clinic Florida, Weston, FloridaAbhishek Deshmukh - Cardiology Department, Mayo Clinic, Rochester, MinnesotaTheodore Schreiber - Cardiology Department, Detroit Medical Center, Detroit, MichiganCindy L Grines - Cardiology Department, Detroit Medical Center, Detroit, MichiganApurva O Badheka - Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.118(11), pp.1705-1711
- DOI
- 10.1016/j.amjcard.2016.08.052
- PMID
- 27677388
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Language
- English
- Date published
- 12/01/2016
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094347102771
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