TY - JOUR
T1 - Association between hospital volume and 30-day readmissions following transcatheter aortic valve replacement
AU - Khera, Sahil
AU - Kolte, Dhaval
AU - Gupta, Tanush
AU - Goldsweig, Andrew
AU - Velagapudi, Poonam
AU - Kalra, Ankur
AU - Tang, Gilbert H.L.
AU - Aronow, Wilbert S.
AU - Fonarow, Gregg C.
AU - Bhatt, Deepak L.
AU - Aronow, Herbert D.
AU - Kleiman, Neal S.
AU - Reardon, Michael
AU - Gordon, Paul C.
AU - Sharaf, Barry
AU - Abbott, J. Dawn
N1 - Funding Information:
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Tang has received personal fees from Edwards Lifesciences and Medtronic. Dr Bhatt has received grants from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company, Roche, Pfizer, Forest Laboratories, Ischemix, Amgen, Eli Lilly, Chiesi, and Ironwood; personal fees from Duke Clinical Research Institute (data monitoring committee [DMC]), Mayo Clinic (DMC), Population Health Research Institute (DMC, clinical trial steering committee for a trial funded by Bayer), Belvoir Publications (editor in chief, Harvard Heart Letter), Slack Publications (chief medical editor, Cardiology Today’s Intervention), WebMD (CME steering committees), Elsevier (advisory board, Elsevier Practice Update Cardiology), HMP Communications (editor in chief, Journal of Invasive Cardiology), Harvard Clinical Research Institute (clinical trial steering committee for trial funded by Boehringer Ingelheim; DMC chair for a trial funded by St Jude), Cleveland Clinic (DMC), and Journal of the American College of Cardiology (guest editor; associate editor); other funding from FlowCo, PLx Pharma, Takeda, Medscape Cardiology (advisory board), Regado Biosciences (advisory board), Boston VA Research Institute (board of directors), Clinical Cardiology (deputy editor), Veterans Administration (chair, VA Cardiovascular Assessment, Reporting, and Tracking System Program; research and publications committee), St Jude Medical (site coinvestigator), Biotronik (site coinvestigator), Cardax (advisory board), American College of Cardiology (chair, NCDR-ACTION Registry steering committee), Boston Scientific (site coinvestigator), and Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); personal fees and nonfinancial support from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org), and Society of Cardiovascular Patient Care (board of directors; secretary/treasurer); and nonfinancial support from the American Heart Association. Dr Reardon has served as a consultant for Medtronic. No other disclosures were reported.
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2017/7
Y1 - 2017/7
N2 - IMPORTANCE With the approval of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis at intermediate surgical risk, TAVR volume is projected to increase exponentially in the United States. The 30-day readmission rate for TAVR was recently reported at 17.9%. The association between institutional TAVR volume and the 30-day readmission metric has not been examined. OBJECTIVE To assess the association between hospital TAVR volume and 30-day readmission. DESIGN, SETTING, AND PARTICIPANTS In this observational study,we used the 2014 Nationwide Readmissions Database to identify hospitals with established TAVR programs (performing at least 5 TAVRs in the first quarter of 2014). Based on annual TAVR volume, hospitals were classified as low (<50), medium (50 to <100), and high (100) volume. Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. Data were analyzed from November to December 2016. EXPOSURE Transcatheter aortic valve replacement. MAIN OUTCOMES AND MEASURES Thirty-day readmissions. RESULTS Of 129 hospitals included in this study, 20 (15.5%) were categorized as low volume, 47 (36.4%) as medium volume, and 62 (48.1%) as high volume. Of 16 252 index TAVR procedures, 663 (4.1%), 3067 (18.9%), and 12 522 (77.0%) were performed at low-, medium-, and high-volume hospitals, respectively. Thirty-day readmission rates were significantly lower in high-volume compared with medium-volume (adjusted odds ratio, 0.76; 95%CI, 0.68-0.85; P < .001) and low-volume (adjusted odds ratio, 0.75; 95%CI, 0.60-0.92; P = .007) hospitals. Noncardiac readmissions were more common in low-volume hospitals (65.6%vs 60.6%in high-volume hospitals), whereas cardiac readmissions were more common in high-volume hospitals (39.4%vs 34.4%in low-volume hospitals). There were no significant differences in length of stay and costs per readmission among the 3 groups (mean [SD], 5.5 [5.0] days vs 5.9 [7.5] days vs 6.0 [5.8] days; P = .74, and $13 886 [18 333] vs $14 135 [17 939] vs $13 432 [15 725]; P = .63, respectively). CONCLUSIONS AND RELEVANCE We report for the first time, to our knowledge, an inverse association between hospital TAVR volume and 30-day readmissions. Lower readmission at higher-volume hospitals was associated with significantly lower cost to the health care system.
AB - IMPORTANCE With the approval of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis at intermediate surgical risk, TAVR volume is projected to increase exponentially in the United States. The 30-day readmission rate for TAVR was recently reported at 17.9%. The association between institutional TAVR volume and the 30-day readmission metric has not been examined. OBJECTIVE To assess the association between hospital TAVR volume and 30-day readmission. DESIGN, SETTING, AND PARTICIPANTS In this observational study,we used the 2014 Nationwide Readmissions Database to identify hospitals with established TAVR programs (performing at least 5 TAVRs in the first quarter of 2014). Based on annual TAVR volume, hospitals were classified as low (<50), medium (50 to <100), and high (100) volume. Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. Data were analyzed from November to December 2016. EXPOSURE Transcatheter aortic valve replacement. MAIN OUTCOMES AND MEASURES Thirty-day readmissions. RESULTS Of 129 hospitals included in this study, 20 (15.5%) were categorized as low volume, 47 (36.4%) as medium volume, and 62 (48.1%) as high volume. Of 16 252 index TAVR procedures, 663 (4.1%), 3067 (18.9%), and 12 522 (77.0%) were performed at low-, medium-, and high-volume hospitals, respectively. Thirty-day readmission rates were significantly lower in high-volume compared with medium-volume (adjusted odds ratio, 0.76; 95%CI, 0.68-0.85; P < .001) and low-volume (adjusted odds ratio, 0.75; 95%CI, 0.60-0.92; P = .007) hospitals. Noncardiac readmissions were more common in low-volume hospitals (65.6%vs 60.6%in high-volume hospitals), whereas cardiac readmissions were more common in high-volume hospitals (39.4%vs 34.4%in low-volume hospitals). There were no significant differences in length of stay and costs per readmission among the 3 groups (mean [SD], 5.5 [5.0] days vs 5.9 [7.5] days vs 6.0 [5.8] days; P = .74, and $13 886 [18 333] vs $14 135 [17 939] vs $13 432 [15 725]; P = .63, respectively). CONCLUSIONS AND RELEVANCE We report for the first time, to our knowledge, an inverse association between hospital TAVR volume and 30-day readmissions. Lower readmission at higher-volume hospitals was associated with significantly lower cost to the health care system.
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U2 - 10.1001/jamacardio.2017.1630
DO - 10.1001/jamacardio.2017.1630
M3 - Article
C2 - 28494061
AN - SCOPUS:85030672144
SN - 2380-6583
VL - 2
SP - 732
EP - 741
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 7
ER -