Early Insights into Trends and Predictors of the Next Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures
Presenter
Jelani K Grant, MD, Jackson Memorial Hospital, Miami, FL
Jelani K Grant, MD1, Louis Vincent, MD2, Bertrand F Ebner, MD2, Jennifer Maning3, Harjit Singh4, Odunayo Olorunfemi5, Neal Olarte, DO6, Rosario Colombo, MD7 and Joao Braghiroli, M.D.6, (1)Jackson Memorial Hospital, Miami, FL, (2)-, Miami, FL, (3)University of Miami/Jackson Memorial Medical Center, Miami, FL, (4)University of Miami, Miami, FL, (5)University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami Beach, FL, (6)University of Miami Miller School of Medicine, Miami, FL, (7)University Of Miami Miller School Of Medicine, Pinecrest, FL
Keywords: TEER/TMVR/Mitral Valve
Background
Early discharge strategies are associated with lower cost and resource utilization during hospitalization, leading to increased popularity in persons undergoing percutaneous cardiac interventions. As such, we sought to evaluate trends, predictors and outcomes of the next day discharge (NDD) approach after transcatheter mitral valve repair (TMVR) procedures.
Methods
The National Inpatient Sample (NIS) was queried between 2013 and 2018 for patients undergoing TMVR using the ICD-9 & 10 procedure codes ‘3597’ and ‘02UG3JZ’. Patients undergoing TMVR were stratified into two groups, determined by hospital length of stay (LOS) [≤1 day, NDD versus >1-day, non-NDD].
Results
Overall, 22,035 patients underwent TMVR with 35.7% (n=7,870) belonging to the NDD group. From 2013 to 2018, the proportion of patients being discharged using the NDD approach trended upward from 18.3% to 46.0% with an average annual increase rate of +22.2%. Amongst clinical factors, frailty (adjusted OR: 6.25, 95% CI: 3.34-12.42), anemia (OR: 2.45, 95% CI: 1.79-3.36), major depressive disorder (OR:1.30, 95% CI 1.15-1.48): , thrombocytopenia (OR: 3.06, 95% CI: 2.65-3.53) and chronic kidney disease (OR: 1.41, 95% CI: 1.32-1.51) were the strongest predictors of non-NDD (p<0.001 for all). Regarding complication trends in the non-NDD cohort; ventricular fibrillation, acute coronary syndromes, pericardial complications, post procedure venous thromboembolism, vascular complications and post procedure cardiogenic shock trended upward (p<0.001 for all) whereas red blood cell transfusions, acute respiratory distress, mechanical ventilation, mechanical circulatory support, acute kidney injury, intraoperative cardiac arrest and post-operative ischemic stroke rates trended down (p<0.001 for all). Pooled post-procedural complications (73.1% to 64.7%, p<0.001) in the non-NDD group trended down from 2013 to 2018 .
Conclusions
Between 2013-2018, nationwide complication rates from TMVR have decreased significantly, while NDD have increased significantly. This may reflect improving operator experience and prioritization of decreasing length of stay.