Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement is Not Associated With Increased Early or Late Readmission Risk

Abstract

BackgroundElderly patients undergoing transcatheter aortic valve replacement (TAVR) are at risk of hospital readmission postprocedure. It is not known whether the index hospital length of stay and, specifically, early discharge post‐TAVR is associated with an increased risk of readmission. We hypothesized a nonlinear relationship whereby both short and long lengths of stay were associated with increased readmission risk.Methods and ResultsWe performed a retrospective multicenter cohort analysis of patients undergoing elective transfemoral TAVR and surviving to discharge between January 2007 and March 2014. The exposure variable was hospital length of stay measured from the procedure date to the date of discharge and modeled as a continuous variable in a multivariable cause‐specific Cox regression. Main outcome measures were 30‐day and 1‐year all‐cause readmissions. The study population consisted of 709 patients with a median length of stay of 6 days (interquartile range, 4–8). At 30‐days and 1‐year, 13.5% and 44.0% of patients were readmitted, respectively. Although post‐TAVR length of stay was not associated with 30‐day all‐cause readmissions (P=0.925), there existed a significant association with 1‐year readmission (P=0.010) after adjustment for baseline clinical variables. The association between post‐TAVR length of stay and 1‐year readmission was linear (P=0.549 for nonlinearity) with no evidence supporting an increased readmission risk for shorter length of stays.ConclusionsAmong elderly survivors of elective transfemoral TAVR, a short postprocedural length of stay was not associated with an increased risk readmission within 30 days or 1 year. However, the risk of 1‐year readmission increased with longer post‐TAVR lengths of stay.

Early discharge and post‐discharge outcomes in patients undergoing radical cystectomy for bladder cancer

“… also concluded that early discharge after colorectal surgery may be implemented without any adverse effect on readmission rates based on the analyses of NSQIP data. The majority of studies on other types of surgery, such as joint arthroplasty, bariatric surgery, lobectomy and aortic valve replacement has also shown no detrimental effects from early discharge . The present study adds to the evidence supporting the hypothesis that early hospital discharge and post‐discharge outcomes are compatible, even for a morbid oncological surgery such as RC.…”

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

“…71 Early (< 3 days) and next-day discharge have been shown to be feasible and safe, [72][73][74] with no increased risk of readmission within 30 days or 1 year. 75 As expected, most patients who experienced vascular or bleeding complications, or those who required insertion of a permanent pacemaker were not eligible for early discharge.…”

In Touch But Out of Time: Aggressive Hospital Discharge and Readmissions After Transcatheter Aortic Valve Replacement

“…Patients in that study underwent TAVR in Ontario between 2007 and 2014; the median length of stay was 6 days and 19% of hospital stays were <4 days. A patient‐level analysis revealed no relationship between length of stay and the 30‐day likelihood of readmission …”

“…The timing of the studies by Dodson and by Sud, and our own study referencing the Nationwide Readmission Database, all point to a major limitation in our current ability to assimilate clinical data, given that all 3 may already be outdated. This problem is particularly vexing in a field that has been as dynamic as TAVR.…”

“…A patient-level analysis revealed no relationship between length of stay and the 30-day likelihood of readmission. 11 Although both studies are essentially negative, they should not be regarded as evidence that aggressive discharge policies should be abandoned. First, in the study of Dodson, the 15.5% contribution made by hospital practice may seem small, but viewed in the context of the fairly subtle differences in readmission rates reported in recent years, this proportion is still fairly substantial.…”