Key result
Same-day discharge after TAVI shows no significant difference in 30-day readmissions vs. later discharge.
Why the study?
There is a paucity of data on the feasibility and safety of same-day discharge following transcatheter aortic valve implantation at a national level.
Does same-day discharge following TAVI increase the risk of 30-day readmissions or complications compared to later discharge in patients with severe aortic stenosis?
Cohort (n=158,591)
Yes
Does same-day discharge following TAVI increase the risk of 30-day readmissions or complications compared to later discharge in patients with severe aortic stenosis?
Same-day discharge after TAVI appears feasible and safe in highly selected patients, reducing hospitalization costs without significantly increasing 30-day readmissions or complications.
Supports same-day TAVI discharge feasibility in selected patients; leaves open randomized confirmation of safety.
Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P =0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P =0.01) but comparable to second‐ or third‐day discharge (log‐rank P =0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle‐branch block, right bundle‐branch block, second‐degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30‐day readmission and complication rates compared with non‐SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
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Zahid et al. (2022) conducted a cohort in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=158,591). Same-day discharge (SDD) vs. Non-same-day discharge (next-day or second/third-day discharge) was evaluated on 30-day readmission (Adjusted OR 1.19, 95% CI 0.96-1.48, p=0.11). Same-day discharge following TAVI was associated with similar 30-day readmission rates compared to non-same-day discharge (9.8% vs 8.9%, adjusted OR 1.19, p=0.11).
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