Hospital Volume and Readmissions After TAVR

Study Questions:

What is the association between hospital transcatheter aortic valve replacement (TAVR) volume and 30-day readmission?

Methods:

This was an observational study using the 2014 Nationwide Readmissions Database to identify hospitals with established TAVR programs (performing at least five TAVRs in the first quarter of 2014). Based on annual TAVR volume, hospitals were classified as low (<50), medium (≥50 to <100), and high (≥100) volume. Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. Data were analyzed from November to December 2016. The main outcome measure was 30-day readmissions.

Results:

Of 129 hospitals included in this study, 20 (15.5%) were categorized as low volume, 47 (36.4%) as medium volume, and 62 (48.1%) as high volume. Of 16,252 index TAVR procedures, 663 (4.1%), 3,067 (18.9%), and 12,522 (77.0%) were performed at low-, medium-, and high-volume hospitals, respectively. Thirty-day readmission rates were significantly lower in high-volume compared with medium-volume (adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.68-0.85; p < 0.001) and low-volume (adjusted odds ratio, 0.75; 95% CI, 0.60-0.92; p = 0.007) hospitals. Noncardiac readmissions were more common in low-volume hospitals (65.6% vs. 60.6% in high-volume hospitals), whereas cardiac readmissions were more common in high-volume hospitals (39.4% vs. 34.4% in low-volume hospitals). There were no significant differences in length of stay and costs per readmission among the three groups (mean [standard deviation], 5.5 [5.0] days vs. 5.9 [7.5] days vs. 6.0 [5.8] days; p = 0.74, and $13,886 [18,333] vs. $14,135 [17,939] vs. $13,432 [15,725]; p = 0.63, respectively).

Conclusions:

The authors concluded that there is an inverse association between hospital TAVR volume and 30-day readmissions.

Perspective:

This observational study reports an inverse association between hospital TAVR volume and 30-day readmission rates, with noncardiac readmissions being more common in low-volume hospitals, whereas cardiac readmissions were more common in high-volume hospitals. Although the cost of all readmissions was similar, lower readmission rates at high-volume hospitals equate to lower health care costs and substantial savings. These data may help guide policy makers in the future to identify targets for optimizing and standardizing TAVR outcomes across hospitals with different volumes. Current strategy should be to use best practices and have TAVR programs analyze their outcomes, compare them with national benchmarks, and take actions that are likely to improve their hard outcomes as well as reduce readmissions.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias

Keywords: Health Care Costs, Hospitals, High-Volume, Hospitals, Low-Volume, Length of Stay, Outcome Assessment (Health Care), Patient Readmission, Primary Prevention, Transcatheter Aortic Valve Replacement, Vascular Diseases


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