Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

Abstract

Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P =0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P =0.01) but comparable to second‐ or third‐day discharge (log‐rank P =0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle‐branch block, right bundle‐branch block, second‐degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30‐day readmission and complication rates compared with non‐SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.

Temporal Trends, Outcomes, and Predictors of Next‐Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score–Matched Analysis

“…Several studies have reported favorable outcomes with same‐day discharge in carefully selected patients undergoing TAVR. 17 , 18 , 19 , 20 However, a recent report from the Nationwide Readmission Database (n=158 591) revealed that same‐day discharge was performed in only 0.6% of patients undergoing TAVR from 2015 to 2019. 20 Similarly, in a recent multicenter study across 7 international TAVR programs only 5.9% were deemed eligible for same‐day discharge.…”

“… 17 , 18 , 19 , 20 However, a recent report from the Nationwide Readmission Database (n=158 591) revealed that same‐day discharge was performed in only 0.6% of patients undergoing TAVR from 2015 to 2019. 20 Similarly, in a recent multicenter study across 7 international TAVR programs only 5.9% were deemed eligible for same‐day discharge. 18 These findings suggest that same‐day discharge is unlikely to be widely adopted, especially with this strategy being feasible only for cases performed earlier in the day.…”

Evolving Devices and Material in Transcatheter Aortic Valve Replacement: What to Use and for Whom

“…The number of TAVR procedures is rapidly increasing, and the continuous expansion of the population deemed suitable for TAVR [ 10 , 11 ] has corresponded with an impressive constant evolution in TAVR devices and materials. Indeed, these advances have significantly reduced periprocedural complications, making it safe to shorten hospital stay and improve long-term outcomes [ 12 , 13 ]. Moreover, these progresses have resulted in a wide armamentarium at our disposal, including bioprostheses presenting different dimensions, designs, and deliverability, providing the opportunity to select a device based on each patient’s clinical and anatomic characteristics.…”