High-Volume TAVR Hospitals Associated With Significantly Lower 30-Day Readmissions

June 2, 2017—An observational study of high-volume transcatheter aortic valve replacement (TAVR) hospitals versus medium- and low-volume TAVR hospitals was recently published by Sahil Khera, MD, et al online ahead of print in Journal of the American Medical Association (JAMA): Cardiology. The investigators concluded, "We report for the first time, to our knowledge, an inverse association between hospital TAVR volume and 30-day readmissions. Lower readmission at higher-volume hospitals was associated with significantly lower cost to the health care system."

The study noted that the 30-day readmission rate for TAVR was recently reported at 17.9%, but the association between institutional TAVR volume and 30-day readmission has not been examined. TAVR volume is projected to increase exponentially in the United States with the approval of TAVR for patients with severe symptomatic aortic stenosis at intermediate surgical risk, advised the investigators.

As summarized in JAMA: Cardiology, the 2014 Nationwide Readmissions Database was used to identify hospitals with established TAVR programs (ie, those that performed ≥ 5 TAVRs in the first quarter of 2014). Based on annual TAVR volume, hospitals were classified as low (< 50), medium (≥ 50 to < 100), and high (≥ 100) volume. Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. Data were analyzed from November to December 2016.

The study included 129 hospitals. Of these, 20 (15.5%) were categorized as low volume, 47 (36.4%) as medium volume, and 62 (48.1%) as high volume. Of 16,252 index TAVR procedures, there were 663 (4.1%) performed at low-volume hospitals; 3,067 (18.9%) at medium-volume hospitals; and 12,522 (77%) performed at high-volume hospitals.

The investigators found that 30-day readmission rates were significantly lower in high-volume compared with medium-volume (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.68–0.85; P < .001) and low-volume (adjusted OR, 0.75; 95% CI, 0.60-0.92; P = .007) hospitals.

Noncardiac readmissions were more common in low-volume hospitals (65.6% vs 60.6% in high-volume hospitals), whereas cardiac readmissions were more common in high-volume hospitals (39.4% vs 34.4% in low-volume hospitals).

Among the three groups, there were no significant differences per readmission in length of stay (mean [standard deviation], 5.5 [5.0] days vs 5.9 [7.5] days vs 6.0 [5.8] days; P = .74) and costs ($13,886 [$18,333] vs $14,135 [$17,939] vs $13,432 [$15,725]; P = .63, respectively), reported the investigators in JAMA: Cardiology.