Key result
Higher hospital volume was associated with significantly lower in-hospital mortality (OR 0.872 per 10 emergency admissions) for patients undergoing emergency transfemoral TAVI.
Why the study?
Although an inverse volume-outcome relationship exists for TAVI, little was known about outcomes among emergency admissions in Germany.
Does treatment at higher volume centers improve in-hospital mortality and complication rates in patients undergoing emergency transcatheter aortic valve implantation?
Observational (n=17,295)
Yes
Does treatment at higher volume centers improve in-hospital mortality and complication rates in patients undergoing emergency transcatheter aortic valve implantation?
Odds Ratio: 0.872
p-value: p=0.043
Higher hospital TAVI volume is associated with significantly lower in-hospital mortality, fewer complications, and reduced resource utilization for emergency TAVI admissions.
Higher-volume centers linked to lower mortality and complications in emergency TAVI; extends observational volume-outcome data but remains hypothesis-generating.
The literature has shown an inverse volume-outcome relationship for transcatheter aortic valve implantation (TAVI). However, little is known about emergency admissions in Germany. Using German national electronic health records, we identified all isolated balloon-expandable and self-expanding transfemoral TAVI in 2018. The focus was on those patients with emergency admission. 17,295 patients were treated with TAVI, including 1682 emergency cases. 49.2% of the emergency admissions were female, the mean age was 81.2 years and the logistic EuroSCORE was 23.3%. The percentage of emergency cases was higher in lower volume than in higher volume centers (p < 0.001): In detail, centers performing < 50 TAVI showed an emergency admission rate of ~ 15%, those with > 200 TAVI a rate of ~ 11%. After propensity score adjustment, analyzing the outcomes for an increase in volume per 10 emergency admissions, higher volume centers showed significantly better outcomes regarding in-hospital mortality (OR = 0.872, p = 0.043), major bleeding (OR = 0.772, p = 0.001), stroke (OR = 0.816, p = 0.044), mechanical ventilation > 48 h (OR = 0.749, p = 0.001), length of hospital stay (risk adjusted difference in days of hospitalization per 10 emergency admissions: - 1.01 days, p < 0.001), and reimbursement (risk adjusted difference in reimbursement per 10 emergency admissions: -€314.89, p < 0.001). Results were not significant for acute kidney injury (OR = 0.951, p = 0.104), postoperative delirium (OR = 0.975, p = 0.480), and permanent pacemaker implantation (OR = 1.010, p = 0.732). In conclusion, regarding transfemoral TAVI, the percentage of emergency cases was higher in lower volume centers in Germany. However, higher volume centers show significantly better outcomes for in-hospital mortality and complication rates as well as resource utilization parameters.
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Oettinger et al. (2022) conducted an observational in Aortic valve stenosis requiring emergency TAVI (n=17,295). Higher hospital volume (per 10 emergency TAVI admissions) vs. Lower hospital volume was evaluated on In-hospital mortality (OR 0.872, p=0.043). Higher hospital volume was associated with significantly lower in-hospital mortality (OR 0.872 per 10 emergency admissions) for patients undergoing emergency transfemoral TAVI.
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