A Comparative Analysis of In-Hospital Outcomes and Care Cost Between Surgical and Transcatheter Valve Replacement for Aortic Stenosis: Insights From the U.S Nationwide Inpatient Sample Database

ABSTRACT Background/objectives Transcatheter aortic valve replacement (TAVR) has emerged as a preferred alternative to surgical aortic valve replacement (SAVR) for symptomatic aortic stenosis. This study aimed to compare the clinical outcomes and care costs of TAVR and SAVR to medical management using five years of inpatient data. Methods Adult hospitalizations with a principal diagnosis of aortic stenosis were analyzed from the Nationwide Inpatient Sample database (2016-2020). Diagnosis and procedure variables, as well as confounders and comorbidities, were identified using the International Classification of Diseases (ICD-10) codes. Multivariable regression models were utilized to assess mortality odds, length of stay (LOS), periprocedural complications, and care costs. Results Among the 364,515 admissions for aortic stenosis analyzed, the mean age was 76 ± 0.5 years, with a majority of male patients (57.8%) and White Americans comprising 85.5% of the population. SAVR was performed in 29.3% of cases, and TAVR in 50.8%. TAVR demonstrated significantly lower in-hospital mortality compared to SAVR (aOR: 0.463; 95% CI: 0.366-0.587; P < 0.001), whereas SAVR did not show a significant difference (aOR: 0.786; 95% CI: 0.601-1.029; P = 0.079). TAVR also resulted in a significantly shorter mean LOS compared to SAVR (adjusted mean LOS: 2.37; 95% CI: 2.12-2.63; P < 0.001 vs. 6.25; 95% CI: 6.00-6.50; P < 0.001). While TAVR patients had a lower likelihood of complications, they incurred higher hospital costs. Conclusion TAVR demonstrated significantly lower odds of in-hospital mortality and shorter length of stay compared to medical management or SAVR. However, TAVR patients incurred higher hospital costs despite a lower likelihood of complications.