30-Days readmission after TAVR in patients with cancer: Outcomes and predictors.
Presenter
Juan Del Cid Fratti MD MS, MD MSc, The University of Washington, Peoria, IL
Juan Del Cid Fratti MD MS, MD MSc1, Miguel Salazar, MD2, Ezequiel Munoz, MD3 and Sudhir Mungee, M.D., FACC, FSCAI3, (1)The University of Washington, Peoria, IL, (2)Cleveland Clinic, Cleveland, OH, (3)University of Illinois College of Medicine at Peoria, Peoria, IL
Keywords: Quality and TAVI/TAVR/Aortic Valve
Background
Hospital readmission after cardiac procedures are a focus of quality improvement efforts. We aim to describe the burden, and factors associated with readmission after TAVR in patients with cancer.
Methods
2017-National Readmission Database (NRD) of adult patients readmitted within 30-days after an index admission for TAVR with a concomitant diagnosis of cancer. We aim to identify 30-day readmission rate, mortality, healthcare-utilization and independent predictors of readmission
Results
2,213 patients with malignancy underwent TAVR. The 30-days readmission rate was 16% (n=355). Main causes of readmission were Heart-failure, sepsis, acute hypercapnic respiratory failure, CAD with angina, and AKI with ATN. Readmitted patients were more likely to come from small metropolitan areas, micropolitan areas, rural hospital, non-teaching hospital, small size hospital, being transfer from a short-term hospital, SNF, and from home health care. Patients re-admitted were more likely to have malnutrition (8% vs 3.2%, p=<0.01), to develop VTE (3.8% vs 0.6, p=<0.01), AKI (26% vs 13.6%, p=<0.01), and to died (4.6% vs 1.7%, p=<0.01). The total health care in-hospital burden of readmission was $5.9 million in charges and $25 million in costs. Independent predictors of readmission were disposition to a short-term skilled nursing facility, and sepsis.
Conclusions
Readmission rate after TAVR in patients with cancer is high and is associated with higher in-hospital mortality rate with a high health care burden. We identified risk factors that can be targeted to decrease readmission after TAVR, health care burden, and patient mortality.
