Short-term Readmission Rates Similar After TAVR vs SAVR


Readmission within 30 days of aortic valve replacement is relatively common but occurs at comparable rates whether patients undergo TAVR or surgery, according to a study published in the August 2015 issue of Circulation: Cardiovascular Interventions.

Take Home: Short-term Readmission Rates Similar After TAVR vs SAVR

Edward L. Hannan, PhD, of the University at Albany (Rensselaer, NY), and colleagues examined data from New York’s Cardiac Surgery Reporting System on 617 patients with severe aortic stenosis who underwent TAVR and 1,981 who had surgical aortic valve replacement (SAVR) between January 2011 and November 2012. Those data were linked with information from the state’s administrative acute care database to determine rates of and reasons for readmission.

After propensity matching, 389 pairs of patients undergoing either TAVR or SAVR remained; all matched pairs came from the same hospital.

Rates of readmission within 30 days were similar both overall and among specific subgroups. The results were consistent after adjustment with a logistic regression model (table 1).

 Table 1. Thirty-Day Readmission Rates in Propensity-Matched Analysis


Further analysis of the 30-day period found that readmissions within 0-3 days and 21-30 days were similarly likely in the TAVR and SAVR groups. There were, however, more readmissions in surgical patients at 4-10 days and more readmissions in TAVR patients at 11-20 days.

The most frequent principal diagnosis among readmitted patients was heart failure in both the TAVR and SAVR groups (21.9% and 19.2%, respectively). Other common diagnoses after TAVR included postoperative infection (11.0%), hemorrhage or hematoma (5.5%), stroke or TIA (4.1%), and respiratory failure (4.1%). After surgery, they included cardiac rhythm disorders (9.6%), stroke or TIA (5.5%), pneumonia (5.5%), pneumothorax/pleural effusion (5.5%), and GI bleeding (5.5%).

Median total length of stay—incorporating the index hospitalization and any readmissions—was 9 days in the TAVR group and 11 in the SAVR group.

Readmission Rates Higher Than With CABG

Because TAVR is less invasive, it could be hypothesized that the procedure would be associated with lower readmission rates compared with surgical valve replacement, although that has never been formally tested, the authors say.

The current study does not support that hypothesis and shows that readmission rates after TAVR and SAVR—which approach 20% for both—are higher than the rate seen following CABG in New York (16.5%).

Dr. Hannan and colleagues note several caveats, however, including the potential impact of selection biases in observational studies; the issue was minimized, though not eliminated, through propensity matching and logistic regression modeling.

Additionally, when constructing the models, the researchers did not have information on certain key patient-level data including frailty, severe hepatic disease without failure, severe pulmonary hypertension, cognitive impairment, and socioeconomic status.


Source: 
Hannan EL, Samadashvili Z, Jordan D, et al. Thirty-day readmissions after transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis in New York state. Circ Cardiovasc Interv. 2015;8:e002744.

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Disclosures
  • Dr. Hannan reported no relevant conflicts of interest.

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