Study Evaluates 30-Day Readmissions After TAVR

January 3, 2017—Findings from a study of 30-day readmission rates after transcatheter aortic valve replacement (TAVR) in the United States were published by Dhaval Kolte, MD, et al online ahead of print in Circulation: Cardiovascular Interventions.

Data on 30-day readmissions after TAVR are limited, and readmissions after cardiac procedures are common and contribute to increased health care utilization and costs, noted the investigators. 

As summarized in Circulation: Cardiovascular Interventions, patients who underwent TAVR between January and November 2013 and survived the index hospitalization were identified in the Nationwide Readmissions Database. The investigators analyzed incidence, predictors, causes, and costs of 30-day readmissions. They reported that 2,188 (17.9%) of 12 ,221 TAVR patients were readmitted within 30 days.

Independent predictors of 30-day readmission were 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).

Readmissions occurred in 61.8% of patients due to noncardiac causes and in 38.2% of patients due to cardiac causes. The most common noncardiac causes were respiratory complications (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%). 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 $8,302 (interquartile range, $5,229–$16, 021), respectively.

The investigators concluded that 30-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and postprocedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs, advised the investigators in Circulation: Cardiovascular Interventions.