Readmission rates and risk factors for readmission after transcatheter aortic valve replacement in patients with end-stage renal disease

Abstract

Objectives We sought to examine readmission rates and predictors of hospital readmission following TAVR in patients with ESRD. Background End-stage renal disease (ESRD) is associated with poor outcomes following transcatheter aortic valve replacement (TAVR). Methods We assessed index hospitalizations for TAVR from the National Readmissions Database from 2017 to 2018 and used propensity scores to match those with and without ESRD. We compared 90-day readmission for any cause or cardiovascular cause. Length of stay (LOS), mortality, and cost were assessed for index hospitalizations and 90-day readmissions. Multivariable logistic regression was performed to identify predictors of 90-day readmission. Results We identified 49,172 index hospitalizations for TAVR, including 1,219 patients with ESRD (2.5%). Patient with ESRD had higher rates of all-cause readmission (34.4% vs. 19.2%, HR 1.96, 95% CI 1.68–2.30, p<0.001) and cardiovascular readmission (13.2% vs. 7.7%, HR 1.85, 95% CI 1.44–2.38, p<0.001) at 90 days. During index hospitalization, patients with ESRD had longer length of stay (mean difference 1.9 days), increased hospital cost (mean difference $42,915), and increased in-hospital mortality (2.6% vs. 0.9%). Among those readmitted within 90 days, patients with ESRD had longer LOS and increased hospital charge, but similar in-hospital mortality. Diabetes (OR 1.86, 95% CI 1.31–2.64) and chronic pulmonary disease (OR 1.51, 95% CI 1.04–2.18) were independently associated with higher odds of 90-day readmission in patients with ESRD. Conclusion Patients with ESRD undergoing TAVR have higher mortality and increased cost associated with their index hospitalization and are at increased risk of readmission within 90 days following TAVR.

Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

“…In contrast, cardiac causes progressively decreased to 20.5%[ 13 - 15 ]. Our study revealed a 32.4% readmission rate for patients with CKD but not ESRD, whereas ESRD patients showed a readmission rate of 34.4% in a separate study[ 16 ] . The continuity and progression of readmission rates across the renal disease continuum favor a direct correlation between worse renal function and higher readmission rates post TAVR.…”

“…Decreased renal reserve predisposing to periprocedural AKI on CKD, decreased glomerular filtration rate, and higher diastolic dysfunction in patients with CKD have been demonstrated to play a role in longer admissions for these patients[ 16 ].…”