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Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis
Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. W...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599464/ https://www.ncbi.nlm.nih.gov/pubmed/31281768 http://dx.doi.org/10.7759/cureus.5005 |
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author | Ahmad, Mansoor Patel, Jay N Loc, Brian L Vipparthy, Sharath C Divecha, Chirag Barzallo, Pablo X Kim, Minchul Baman, Timir Barzallo, Marco Mungee, Sudhir |
author_facet | Ahmad, Mansoor Patel, Jay N Loc, Brian L Vipparthy, Sharath C Divecha, Chirag Barzallo, Pablo X Kim, Minchul Baman, Timir Barzallo, Marco Mungee, Sudhir |
author_sort | Ahmad, Mansoor |
collection | PubMed |
description | Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions. |
format | Online Article Text |
id | pubmed-6599464 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-65994642019-07-06 Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis Ahmad, Mansoor Patel, Jay N Loc, Brian L Vipparthy, Sharath C Divecha, Chirag Barzallo, Pablo X Kim, Minchul Baman, Timir Barzallo, Marco Mungee, Sudhir Cureus Cardiology Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions. Cureus 2019-06-26 /pmc/articles/PMC6599464/ /pubmed/31281768 http://dx.doi.org/10.7759/cureus.5005 Text en Copyright © 2019, Ahmad et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Cardiology Ahmad, Mansoor Patel, Jay N Loc, Brian L Vipparthy, Sharath C Divecha, Chirag Barzallo, Pablo X Kim, Minchul Baman, Timir Barzallo, Marco Mungee, Sudhir Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title | Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title_full | Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title_fullStr | Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title_full_unstemmed | Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title_short | Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis |
title_sort | permanent pacemaker implantation after transcatheter aortic valve replacement: a cost analysis |
topic | Cardiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599464/ https://www.ncbi.nlm.nih.gov/pubmed/31281768 http://dx.doi.org/10.7759/cureus.5005 |
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