Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip
Background: Post-procedural hospital length of stay (P-LOS) is an important determinant of cost-related outcomes. In the present study, we aimed to assess the impact of P-LOS on short-term outcomes after transcatheter aortic valve replacement (TAVR) and MitraClip. Methods: We performed a retrospecti...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602222000477 |
| _version_ | 1828404758243704832 |
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| author | Omar M. Abdelfattah Abdelrahman I. Abushouk Anas M. Saad Mohamed M. Gad Toshiaki Isogai Yehia Saleh Shashank Shekhar Mina Iskander Mohamed Omer Ryan Kaple Amar Krishnaswamy Samir R. Kapadia |
| author_facet | Omar M. Abdelfattah Abdelrahman I. Abushouk Anas M. Saad Mohamed M. Gad Toshiaki Isogai Yehia Saleh Shashank Shekhar Mina Iskander Mohamed Omer Ryan Kaple Amar Krishnaswamy Samir R. Kapadia |
| author_sort | Omar M. Abdelfattah |
| collection | DOAJ |
| description | Background: Post-procedural hospital length of stay (P-LOS) is an important determinant of cost-related outcomes. In the present study, we aimed to assess the impact of P-LOS on short-term outcomes after transcatheter aortic valve replacement (TAVR) and MitraClip. Methods: We performed a retrospective cohort study, retrieving data from the National Readmissions Database (NRD) for patients who underwent transfemoral TAVR and MitraClip between January 2014 and December 2017. We employed multivariable logistic regression to evaluate the association between P-LOS and 30-day all-cause mortality and readmissions. Results: A total of 65,726 and 7347 patients underwent TAVR and MitraClip, respectively within the study period. After 30 days of discharge, 13.7% and 15.1% of TAVR and MitraClip patients were readmitted for any reason, while 0.5% and 0.9% died within the readmission hospitalization. A longer P-LOS was associated with an increased risk of 30-day all-cause readmission in both TAVR (OR = 1.027, 95% CI [1.023–1.032]) and MitraClip (OR = 1.025, 95%CI [1.012–1.038]) patients. This finding remained true for patients who developed or did not develop complications after both procedures. In terms of 30-day inhospital mortality, a longer P-LOS was associated with a higher risk in TAVR patients (OR = 1.039, 95%CI [1.028–1.049]), but no increased risk in MitraClip patients (OR = 1.014, 95%CI [0.985–1.044]). Other predictors of 30-day readmission after both procedures included heart failure, post-procedural acute kidney injury, and discharge with disability. Conclusion: The current study shows that shorter P-LOS was associated with reduced risk of short-term readmission after both TAVR and MitraClip and reduced short-term mortality after TAVR (mainly in patients who developed post-procedural complications). Shorter P-LOS is a predictor of readmission and sicker patient group. Patients requiring longer LOS should be followed closely to prevent readmission and enhance better outcomes. Future studies evaluating P-LOS impact on long-term and patient-oriented outcomes are needed. |
| first_indexed | 2024-12-10T10:41:20Z |
| format | Article |
| id | doaj.art-d112af21111c45cbbac5f127ec5f04c2 |
| institution | Directory Open Access Journal |
| issn | 2666-6022 |
| language | English |
| last_indexed | 2024-12-10T10:41:20Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj.art-d112af21111c45cbbac5f127ec5f04c22022-12-22T01:52:19ZengElsevierAmerican Heart Journal Plus2666-60222022-01-0113100130Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClipOmar M. Abdelfattah0Abdelrahman I. Abushouk1Anas M. Saad2Mohamed M. Gad3Toshiaki Isogai4Yehia Saleh5Shashank Shekhar6Mina Iskander7Mohamed Omer8Ryan Kaple9Amar Krishnaswamy10Samir R. Kapadia11Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Internal Medicine Department, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USAInternal Medicine Department, Cleveland Clinic, Cleveland, OH, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USADepartment of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Corresponding author at: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.Background: Post-procedural hospital length of stay (P-LOS) is an important determinant of cost-related outcomes. In the present study, we aimed to assess the impact of P-LOS on short-term outcomes after transcatheter aortic valve replacement (TAVR) and MitraClip. Methods: We performed a retrospective cohort study, retrieving data from the National Readmissions Database (NRD) for patients who underwent transfemoral TAVR and MitraClip between January 2014 and December 2017. We employed multivariable logistic regression to evaluate the association between P-LOS and 30-day all-cause mortality and readmissions. Results: A total of 65,726 and 7347 patients underwent TAVR and MitraClip, respectively within the study period. After 30 days of discharge, 13.7% and 15.1% of TAVR and MitraClip patients were readmitted for any reason, while 0.5% and 0.9% died within the readmission hospitalization. A longer P-LOS was associated with an increased risk of 30-day all-cause readmission in both TAVR (OR = 1.027, 95% CI [1.023–1.032]) and MitraClip (OR = 1.025, 95%CI [1.012–1.038]) patients. This finding remained true for patients who developed or did not develop complications after both procedures. In terms of 30-day inhospital mortality, a longer P-LOS was associated with a higher risk in TAVR patients (OR = 1.039, 95%CI [1.028–1.049]), but no increased risk in MitraClip patients (OR = 1.014, 95%CI [0.985–1.044]). Other predictors of 30-day readmission after both procedures included heart failure, post-procedural acute kidney injury, and discharge with disability. Conclusion: The current study shows that shorter P-LOS was associated with reduced risk of short-term readmission after both TAVR and MitraClip and reduced short-term mortality after TAVR (mainly in patients who developed post-procedural complications). Shorter P-LOS is a predictor of readmission and sicker patient group. Patients requiring longer LOS should be followed closely to prevent readmission and enhance better outcomes. Future studies evaluating P-LOS impact on long-term and patient-oriented outcomes are needed.http://www.sciencedirect.com/science/article/pii/S2666602222000477Transcatheter mitral valve repairMitraClipTAVRHospital stayMortalityReadmission |
| spellingShingle | Omar M. Abdelfattah Abdelrahman I. Abushouk Anas M. Saad Mohamed M. Gad Toshiaki Isogai Yehia Saleh Shashank Shekhar Mina Iskander Mohamed Omer Ryan Kaple Amar Krishnaswamy Samir R. Kapadia Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip American Heart Journal Plus Transcatheter mitral valve repair MitraClip TAVR Hospital stay Mortality Readmission |
| title | Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip |
| title_full | Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip |
| title_fullStr | Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip |
| title_full_unstemmed | Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip |
| title_short | Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip |
| title_sort | impact of post procedural length of stay on short term outcomes and readmissions after tavr and mitraclip |
| topic | Transcatheter mitral valve repair MitraClip TAVR Hospital stay Mortality Readmission |
| url | http://www.sciencedirect.com/science/article/pii/S2666602222000477 |
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