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Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement

BACKGROUND: Data on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown. METHODS AND RESULTS: We used the...

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Autores principales: Kolte, Dhaval, Kennedy, Kevin, Wasfy, Jason H., Jena, Anupam B., Elmariah, Sammy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200708/
https://www.ncbi.nlm.nih.gov/pubmed/33938233
http://dx.doi.org/10.1161/JAHA.120.021350
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author Kolte, Dhaval
Kennedy, Kevin
Wasfy, Jason H.
Jena, Anupam B.
Elmariah, Sammy
author_facet Kolte, Dhaval
Kennedy, Kevin
Wasfy, Jason H.
Jena, Anupam B.
Elmariah, Sammy
author_sort Kolte, Dhaval
collection PubMed
description BACKGROUND: Data on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown. METHODS AND RESULTS: We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TAVRs. Hierarchical logistic regression models were used to examine between‐hospital variation in 30‐day all‐cause risk‐standardized readmission rate (RSRR) after TAVR and to explore reasons underlying hospital variation in 30‐day RSRR. The study included 27 091 index TAVRs performed across 325 hospitals. The median (interquartile range) hospital‐level 30‐day RSRR was 11.9% (11.1%–12.8%) ranging from 8.8% to 16.5%. After adjusting for differences in patient characteristics, there was significant between‐hospital variation in 30‐day RSRR (hospital odds ratio, 1.59; 95% CI, 1.39–1.77). Differences in length of stay and discharge disposition accounted for 15% of the between‐hospital variance in RSRRs. There was no significant association between hospital characteristics and 30‐day readmission rates after TAVR. There was statistically significant but weak correlation between 30‐day RSRR after TAVR and that after surgical aortic valve replacement, percutaneous coronary intervention, acute myocardial infarction, heart failure, and pneumonia (r=0.132–0.298; P<0.001 for all). Causes of 30‐day readmission varied across hospitals, with noncardiac readmissions being more common at the bottom 5% hospitals (ie, those with the highest RSRRs). CONCLUSIONS: There is significant variation in 30‐day RSRR after TAVR across hospitals that is not entirely explained by differences in patient or hospital characteristics as well as hospital‐wide practice patterns. Noncardiac readmissions are more common in hospitals with the highest RSRRs.
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spelling pubmed-82007082021-06-15 Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement Kolte, Dhaval Kennedy, Kevin Wasfy, Jason H. Jena, Anupam B. Elmariah, Sammy J Am Heart Assoc Original Research BACKGROUND: Data on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown. METHODS AND RESULTS: We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TAVRs. Hierarchical logistic regression models were used to examine between‐hospital variation in 30‐day all‐cause risk‐standardized readmission rate (RSRR) after TAVR and to explore reasons underlying hospital variation in 30‐day RSRR. The study included 27 091 index TAVRs performed across 325 hospitals. The median (interquartile range) hospital‐level 30‐day RSRR was 11.9% (11.1%–12.8%) ranging from 8.8% to 16.5%. After adjusting for differences in patient characteristics, there was significant between‐hospital variation in 30‐day RSRR (hospital odds ratio, 1.59; 95% CI, 1.39–1.77). Differences in length of stay and discharge disposition accounted for 15% of the between‐hospital variance in RSRRs. There was no significant association between hospital characteristics and 30‐day readmission rates after TAVR. There was statistically significant but weak correlation between 30‐day RSRR after TAVR and that after surgical aortic valve replacement, percutaneous coronary intervention, acute myocardial infarction, heart failure, and pneumonia (r=0.132–0.298; P<0.001 for all). Causes of 30‐day readmission varied across hospitals, with noncardiac readmissions being more common at the bottom 5% hospitals (ie, those with the highest RSRRs). CONCLUSIONS: There is significant variation in 30‐day RSRR after TAVR across hospitals that is not entirely explained by differences in patient or hospital characteristics as well as hospital‐wide practice patterns. Noncardiac readmissions are more common in hospitals with the highest RSRRs. John Wiley and Sons Inc. 2021-05-03 /pmc/articles/PMC8200708/ /pubmed/33938233 http://dx.doi.org/10.1161/JAHA.120.021350 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Kolte, Dhaval
Kennedy, Kevin
Wasfy, Jason H.
Jena, Anupam B.
Elmariah, Sammy
Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title_full Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title_fullStr Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title_full_unstemmed Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title_short Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement
title_sort hospital variation in 30‐day readmissions following transcatheter aortic valve replacement
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200708/
https://www.ncbi.nlm.nih.gov/pubmed/33938233
http://dx.doi.org/10.1161/JAHA.120.021350
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