Key result
Chronic systemic steroid use in patients undergoing transcatheter aortic valve replacement did not significantly impact discharge disposition, with 65.5% of steroid users discharged home compared to 66.4% of non-users.
Why the study?
Chronic steroid use is debilitating to health, but its effect on discharge disposition in patients undergoing TAVR was unexamined.
Does chronic steroid use affect discharge disposition and hospital outcomes in patients undergoing transcatheter aortic valve replacement?
Cohort (n=44,200)
Yes
Does chronic steroid use affect discharge disposition and hospital outcomes in patients undergoing transcatheter aortic valve replacement?
Absolute Event Rate: 65.5% vs 66.4%
p-value: p=0.17
Despite a higher baseline comorbidity burden, chronic steroid use does not significantly worsen discharge disposition, length of stay, or in-hospital mortality in patients undergoing TAVR.
Chronic steroid use was not associated with worse TAVR outcomes; leaves open causal effects and requires prospective confirmation.
Background Chronic steroid use is debilitating to health, but, in some cases, it is necessary. We examined the effect of chronic steroid use on the discharge disposition of people undergoing transcatheter aortic valve replacement (TAVR). Methods We queried the National Inpatient Sample Database (NIS) from 2016 to 2019. We identified patients with current chronic steroid use with the International Classification of Diseases for the Tenth (ICD-10) code Z7952. Furthermore, we used the ICD-10 procedure codes for TAVR 02RF3. Outcomes were the length of hospitalization (LOS), Charlson Comorbidity Index (CCI), disposition, in-hospital mortality, and total hospital charges (THC). Results Between 2016 and 2019, we identified 44,200 TAVR hospitalizations, and 382,497 were on current long-term steroid therapy. Of these, 934 had current chronic steroid use and underwent TAVR (STEROID) with a mean age of 78 (SD=8.4). About 50% were female, 89% were Whites, 3.7% were Blacks, 4.2% were Hispanics, and 1.3% were Asians. Disposition was 'home,' 'home with home health' (HWHH), 'skilled nursing home' (SNF), 'short-term inpatient therapy' (SIT), 'discharged against medical advice' (AMA), and 'died.' A total of 602 (65.5%) were discharged home, 206 ( 22%) were discharged to HWHH, 109 (11.7%) to SNF, and 12 (1.28%) died. In the SIT and AMA groups, there were only three and two patients, respectively, p=0.23. The group that underwent TAVR and was not on chronic steroid therapy (NOSTEROID) had a mean age of 79 (SD=8.5), with 28731 (66.4%) being discharged home, 8399 (19.4%) to HWHH, 5319 (12.3%) to SNF, and 617 (1.43%) died p=0.17. Comparing the STEROID vs. NONSTEROID group, according to the CCI, the STEROID group scored higher than the NOSTEROID group; 3.5 (SD=2) vs. 3 (SD=2) p=0.0001, while for LOS, it was 3.7 days (SD=4.3) vs. 4.1 days (SD=5.3), p=0.28, and the THC was $203,213 (SD=$110,476) vs. $215,858 (SD=$138,540), p=0.15. Conclusion The comorbidity burden of individuals on long-term steroids undergoing TAVR was slightly higher than those not on steroids undergoing TAVR. Despite this, there was no statistically significant difference in their hospital outcomes following TAVR with respect to dispositions.
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Evbayekha et al. (2023) conducted a cohort in Aortic stenosis requiring TAVR (n=44,200). Chronic systemic steroid use vs. No chronic steroid therapy was evaluated on Discharge disposition to home (p=0.17). Chronic systemic steroid use in patients undergoing transcatheter aortic valve replacement did not significantly impact discharge disposition, with 65.5% of steroid users discharged home compared to 66.4% of non-users.
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