Key result
The use of the National Readmission Database to compare valve-in-valve TAVR versus reoperative SAVR is limited by non-specific ICD codes and the lack of out-of-hospital mortality data.
This commentary raises methodological concerns regarding the use of the National Readmission Database to accurately identify valve-in-valve TAVR patients and assess true 30-day mortality.
This commentary refers to ‘Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes’, by SA Hirji et al., 2020;41:2747–2755. Hirji et al. 1 reported outcomes of valve-in-valve transcatheter aortic valve replacement (TAVR) vs. reoperative surgical aortic valve replacement from the national readmission database (NRD) 2012–16.2 We have a few concerns that we would like to bring to the author’s attention. They mentioned International Classification of Diseases (ICD)-9th (424.1, 996.02) and 10th (I35.x and either T82.01XA or T82.02XA or T82.03XA or T82.09XA or T82.221A or T82.222A or T82.223A or T82.228A or Z45.09 or Z95.2 or T82.857A) clinical modification codes to identify patients with failed or degenerated bioprosthesis. However, all these codes only identify patients with mechanical complications of the heart valve prosthesis and not specifically aortic valve bioprosthesis. Hence, we wonder if patients with complications of other bioprosthetic valve disorders were incorrectly classified as degenerated bioprosthesis of the aortic valve, and were labelled as valve-in-valve TAVR instead of native valve TAVR. To the best of our knowledge, there are no specific ICD-9 or ICD-10 codes that exist to identify aortic valve bioprosthesis for NRD 2012–16. Furthermore, the authors reported 30-day mortality as a primary outcome. The NRD lacks mortality data on patients who die out of hospital, in the emergency department, and out of state. Therefore, we suggest it is actually ‘30-day readmission mortality’ within the same state that authors have reported in this study rather than true 30-day mortality. Conflict of interest: none declared.
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Nazir et al. (2020) conducted a letter in Failed or degenerated aortic valve bioprosthesis. Valve-in-valve transcatheter aortic valve replacement (TAVR) vs. Reoperative surgical aortic valve replacement was evaluated on 30-day mortality. The use of the National Readmission Database to compare valve-in-valve TAVR versus reoperative SAVR is limited by non-specific ICD codes and the lack of out-of-hospital mortality data.
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