부산대학교 도서관

Background: Readmission rates are a widely accepted quality indicator. Our objective was to study characteristics of readmissions at 30 and 180 days after Transcatheter Aortic Valve Replacement (TAVR).Methods: Patients undergoing TAVR between 2016 and 2017 in the U.S. Nationwide Readmission Database were evaluated for the rates, causes, predictors, and mortality of readmission at 30 and multiple readmission within 180 days after index discharge.Results: This analysis included 89601 hospitalizations; 13% were readmitted within 30 days and 8.7% were readmitted multiple times within 180 days. Most important predictors of readmissions, were Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.47-1.71 at 30 days & HR 1.72; 95% CI 1.58-1.87 at 180 days), > 4 Charlson comorbidities (HR 1.27; 95% CI, 1.19-1.34 at 30 days & HR, 1.54; 95% CI, 1.44-1.65 at 180 days), discharge to skilled nursing facility (HR, 1.34; 95% CI, 1.24-1.44 at 30 days & HR, 1.49; 95% CI, 1.36-1.65 ), atrial fibrillation (HR, 1.25; 95% CI, 1.18-1.32 at 30 days & HR, 1.35; 95% CI, 1.26-1.45 at 180 days), Transapical TAVR approach (HR, 1.21; 95% CI, 1.04-1.42 & HR, 1.20; 95% CI, 1.01-1.43 at 180 days), and acute kidney injury (HR, 1.22; 95% CI, 1.12-1.32 at 30 days & HR, 1.1; 95% CI, 1.01-1.21 at 180 days)(Figure 1 A,B). 67% patients were readmitted at least 1 time within 180 days, 22% were readmitted 2 times within 180days and 11% were readmitted more than 3 times within 180 days. Readmissions were because of noncardiac causes in 67.8% of cases and because of cardiac causes in 32.2% of cases.Conclusion: The study demonstrates that baseline comorbidities alongside non-cardiac causes contributed significantly to readmissions after TAVR at both 30 days and 180 days. The results help to target the susceptible patients in both short as well as long term and to provide evidence-based interventions to reduce the risk and financial burden associated with readmissions.