Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge

Abstract

Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support devices, renal failure were associated with lower odds for early discharge. Transfemoral approach and prior aortic valvuloplasty increased the likelihood for early discharge. Post-TAVI length of stay was associated with significantly higher hospitalization costs.

Exploring the Reduction in Hospitalization Costs Associated with Next-Day Discharge following Transfemoral Transcatheter Aortic Valve Replacement in the United States

“…24 Single site studies have reported savings of $10,000 to $16,000 for patients treated with a minimalist approach and discharged within shorter LOS without compromising patient safety. [25][26][27] The recent publication of the Multimodality, Multidisciplinary but Minimalist TAVR (3M TAVR) study demonstrated the safety and reproducibility of the Vancouver TAVR Clinical Pathway 23 to facilitate NDD home in over 50% patients screened at 13 TAVR centers of varying procedural volume and program maturity while achieving excellent clinical outcomes. 13 Careful attention to all components of patients' journey of care is essential to consistently achieve similar results.…”

Minimalist approach for transcatheter aortic valve replacement

“…Attizzani et al 4 also reported that minimalist approach saved $16,000.00/ case. Similarly, TAVR under LA/CS 12 or post-TAVR early discharge 13 has been advantageous regarding fewer resource use as well as hospitalization costs. TAVR in the inoperable or high surgical risk patients also provides good cost-effectiveness with favorable outcomes compared with SAVR or medical management.…”

“…a similar 30-day mortality or rehospitalization rate compared with late discharge (>2 or 3 days), 11,44,45 while carrying the advantage of reduced hospitalization costs. 13,14 Recently, the safety of next day discharge was directly evaluated in comparison with non-next day discharge, 14 demonstrating comparable 30-day mortality and rehospitalization rates between the two groups. In the largest study, 46 next day discharge (n=132) was not associated with an increased hazard of the 30-day composite of mortality or rehospitalization compared with non-next day discharge (n=117; HR: 0.62; 95%CI: 0.20-1.91; p=0.41), and at one year, next day discharge even showed better composite outcome (HR: 0.47; 95%CI: 0.27-0.81; p=0.006).…”

“…However, these studies are limited by their retrospective, non-randomized design, and early discharge patients had fewer risk factors associated with adverse outcomes, 7 which consequently indicates the existence of selection bias affecting outcomes of these studies. New York Heart Association (NYHA) class IV, 44 baseline renal dysfunction, 13,46 atrial fibrillation, 46 previous balloon aortic valvuloplasty, bleeding or vascular complications, 13,44,45 blood transfusion, 13,45 peri-procedural stroke, 13 mechanical circulatory support devices, 13 new permanent pacemaker implantation, 13,45 and acute kidney injury were negatively associated with the early discharge, whereas male sex, younger age, pre-TAVR permanent pacemaker, and TAVR under LA/CS were associated with a higher probability of early discharge. 13,[44][45][46] Early discharge seems to be safely performed in selected patients who have favorable baseline characteristics (younger age, stable symptoms, preserved renal function, etc.)…”

TAVI: Simplification Is the Ultimate Sophistication

“…Early discharge was evaluated in the literature demonstrating safety in patients with hospitalization duration shorter than 48 h ( 39 ). Indeed, the median length of hospitalization was 1 day in the early discharge group with no differences between early discharge and discharge after 48 h in terms of 1-month mortality, stroke and readmission.…”