Why the study?
End-stage renal disease is associated with poor outcomes following TAVR, but readmission rates and predictors of readmission required examination.
Does end-stage renal disease increase the risk of 90-day readmission and mortality in patients undergoing transcatheter aortic valve replacement?
Does end-stage renal disease increase the risk of 90-day readmission and mortality in patients undergoing transcatheter aortic valve replacement?
In patients undergoing TAVR, the presence of ESRD is associated with significantly higher 90-day all-cause and cardiovascular readmission rates, as well as increased index hospitalization mortality, length of stay, and costs.
Answers are grounded in this paper and cite their sources.
ESRD was associated with higher 90-day readmissions after TAVR; leaves open whether targeted interventions improve outcomes in this population.
OBJECTIVES: We sought to examine readmission rates and predictors of hospital readmission following TAVR in patients with ESRD. BACKGROUND: End-stage renal disease (ESRD) is associated with poor outcomes following transcatheter aortic valve replacement (TAVR). METHODS: We assessed index hospitalizations for TAVR from the National Readmissions Database from 2017 to 2018 and used propensity scores to match those with and without ESRD. We compared 90-day readmission for any cause or cardiovascular cause. Length of stay (LOS), mortality, and cost were assessed for index hospitalizations and 90-day readmissions. Multivariable logistic regression was performed to identify predictors of 90-day readmission. RESULTS: We identified 49,172 index hospitalizations for TAVR, including 1,219 patients with ESRD (2.5%). Patient with ESRD had higher rates of all-cause readmission (34.4% vs. 19.2%, HR 1.96, 95% CI 1.68-2.30, p<0.001) and cardiovascular readmission (13.2% vs. 7.7%, HR 1.85, 95% CI 1.44-2.38, p<0.001) at 90 days. During index hospitalization, patients with ESRD had longer length of stay (mean difference 1.9 days), increased hospital cost (mean difference $42,915), and increased in-hospital mortality (2.6% vs. 0.9%). Among those readmitted within 90 days, patients with ESRD had longer LOS and increased hospital charge, but similar in-hospital mortality. Diabetes (OR 1.86, 95% CI 1.31-2.64) and chronic pulmonary disease (OR 1.51, 95% CI 1.04-2.18) were independently associated with higher odds of 90-day readmission in patients with ESRD. CONCLUSION: Patients with ESRD undergoing TAVR have higher mortality and increased cost associated with their index hospitalization and are at increased risk of readmission within 90 days following TAVR.
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Park et al. (2022) studied this question.
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