부산대학교 도서관

Introduction:The MitraClip (MC) has emerged as an alternative to operative mitral repair in patients at high surgical risk. Since receiving FDA approval in 2013, there is widespread use of MC and, given the novel nature of this technology, it remains unclear if outcomes vary significantly between teaching and non-teaching facilities. This study aimed to define the impact of hospital teaching status (HTS) on patient outcomes following MC in the United States.Hypothesis:Teaching status of hospitals impact the outcomes following MC.Methods:The National Inpatient Sample between 2012 and 2016 was used to identify patients receiving MC according to ICD-9/10 codes. HTS was divided into teaching hospitals (TH) and non-teaching hospitals (NTH) and differences in patient demographics, clinical characteristics, and clinical endpoints were assessed. Case complexity was assessed using APRDRG codes and patients were defined as having high or low case severity as well as high or low risk of mortality. Chi-squared test and t-test were used to assess significance.Results:In total, there were 2004 MC, with the majority (90.5%) in TH. The average age was 76.1 years in both hospitals with no significant difference in the number of women between TH and NTH (46.8% vs. 49.7%, p = 0.44). In-hospital mortality was similar in TH and NTH (2.4% vs. 2.6%, p=0.871) with more systolic heart failure in TH (36.7% vs. 26.7%, p=0.006). Total charges were higher in TH ($211,112 vs. $180,654, p=0.023) with a similar length of stay (LOS) of 5.9 days (p=0.973). Interestingly, when compared to patients in NTH, TH had more subjects with high mortality risk (48.8% vs. 38.7%, p=0.008) and tended to have high case severity (51.4% vs. 45.0%, p=0.096).Conclusions:In-hospital mortality and LOS was not different in patients receiving MC at either TH or NTH, although total charges were higher in TH. However, patients in TH tended to be sicker as evidenced by higher case severity and higher risk of mortality.