Impact of Diabetes Mellitus on Short-Term In-Hospital Outcomes in Patients Undergoing Surgical vs. Transcatheter Aortic Valve Replacement Procedures

Background
Transcatheter aortic valve replacement (TAVR) is an effective treatment for patients with symptomatic valvular stenosis who are ineligible or at high risk for the traditional option of surgical aortic valve replacement (SAVR). Previous studies explored outcomes in SAVR and TAVR procedures. Diabetes mellitus (DM) has significant impact on decision making among patients undergoing aortic valve replacement for severe stenosis. This study aims to further compare SAVR vs. TAVR in patients with DM.

Methods
This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients (18+) from 2012-2015 who underwent SAVR or TAVR. ICD-9 codes were used to identify patients with DM and to exclude patients missing identifiers (age, gender, death). Patients with aortic insufficiency, concomitant coronary artery bypass graft, mitral, tricuspid, pulmonic valve surgery, or atrial or ventricular septal defect closure were also excluded as combined surgery may affect outcomes. Data analyses assessed length of stay (LOS), total charges, age of admission and mortality.

Results
Of the 47,501 who underwent SAVR or TAVR, 13,134 had DM without complications, and 2,657 had DM with complications.

In patients with diabetes without complications, significant increases were observed in:

- LOS in SAVR vs TAVR (9.03 vs. 6.95 days, p<0.0001)

- Total charges in SAVR vs TAVR ($176,521.70 vs. $169,426.35, p=0.03)

- Mortality in SAVR vs TAVR (3.4% vs. 2.7%, p<0.0001)

Age of admission was significantly increased in TAVR (73.07 vs. 68.86 years, p<0.0001)

In patients with diabetes with complications, significant increases (all p<0.0001) were observed in:

- LOS in SAVR vs TAVR (10.8 vs. 7.20 days)

- Total charges in SAVR vs TAVR ($187,351.56 vs. $162,606.64)

- Mortality in SAVR vs TAVR (5.9% vs. 3.4%)

Age of admission was significantly increased in TAVR (71.44 vs. 68.38 years, p<0.0001)

Conclusions
Patients who underwent SAVR with DM suffer from increased LOS, mortality and total charges. The results of this study can aid clinicians in making important procedural decisions within this population. Peri-procedural optimization of symptomatic patients is one potential avenue to reduce LOS, total charges, mortality and improve patient outcomes.