Patients undergoing transcatheter aortic valve replacement (TAVR) at hospitals with mortality rates above the national average may have more than double the risk of dying within 30 days of the procedure compared to those at hospitals below the national average, according to a research letter published Dec. 7 in the Journal of the American College of Cardiology.

Researchers led by Harlan M. Krumholz, MD, SM, FACC, studied hospital performance on TAVR and looked at the 14,722 TAVR procedures for Medicare fee-for-service beneficiaries aged ≥65 years performed at 417 hospitals between 2011 and 2013. These hospitals performed at least one TAVR procedure during the study period, and the median number of TAVRs performed per hospital during the study period was 17. 

They used a mixed model to estimate the odds ratio of death within 30 days at a hospital that is one standard deviation above the national average 30-day mortality rate relative to undergoing TAVR at a hospital that is one standard deviation below the national average, adjusting for patient characteristics. The researchers made similar models for one-year mortality and 30-day readmission.

Results showed that for an individual patient, the between-hospital variation translated to a greater than two-fold higher risk of dying within 30-days for a patient undergoing TAVR at a hospital one standard deviation above the national average compared with undergoing TAVR at a hospital one standard deviation below the national average. The between-hospital variation was lower for one-year mortality and 30-day readmission, but remained substantial.

“This study serves as an important benchmark for quality measurement and future performance improvement efforts for TAVR,” the authors conclude. “Moving forward, as more centers and operators become more proficient, it will be important to continue to monitor the extent of hospital variation to ensure the delivery of optimal outcomes for patients.” 

Keywords: Fee-for-Service Plans, Medicare, Odds Ratio, Patient Readmission, Transcatheter Aortic Valve Replacement

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