1
|
Diaz-Castrillon CE, Kliner D, Serna-Gallegos D, Toma C, Smith AJC, Gada H, Makani A, Hasan I, Ogami T, Wang Y, Sultan I. Readmission Mortality After TAVR: The Combined Effect of Teaching Hospital Status and Cause of Readmission. CJC Open 2025; 7:481-488. [PMID: 40433130 PMCID: PMC12105757 DOI: 10.1016/j.cjco.2024.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2024] [Indexed: 05/29/2025] Open
Abstract
Background Variability in transcatheter aortic valve replacement (TAVR) readmission rates highlights the importance of assessing post-discharge outcomes. Understanding how teaching hospital status and causes of readmission influence mortality could optimise post-TAVR care. Methods Using the National Readmissions Database, we identified 155,298 TAVR admissions from 2012 to 2020. We evaluated the interaction effect between teaching status and cause of readmission on readmission-related mortality through adjusted mixed-effects models. Results Overall, 18.9% of patients (n = 29,479) had a nonelective readmission within 90 days, with no significant difference between teaching and nonteaching hospitals (19.3% vs 18.9%; P > 0.05). Cardiac-related readmissions accounted for 42.7% of cases, while noncardiac readmissions made up 57.3%, with no differences observed in their distribution between teaching and nonteaching hospitals. The unadjusted 90-day readmission mortality rate was 3.8%, without significant differences between teaching and nonteaching hospitals (3.8% vs 4.1%; P = 0.38). A downward trend in nonelective readmission and readmission-related mortality rates was observed, regardless of teaching status. An interaction effect between teaching status and the cause of readmission was identified: Noncardiac readmissions to teaching hospitals were associated with increased odds of death (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.59-2.07; P < 0.001) compared with nonteaching hospitals, whereas cardiac readmissions to teaching hospitals were associated with decreased odds of in-hospital mortality (OR 0.55, 95% CI 0.48-0.62; P < 0.001). Conclusion Our findings indicate a differential association between teaching hospital status and 90-day readmission mortality, contingent on the cause of readmission. Further research, including the use of metrics such as failure to rescue, is needed to better understand the relationship between patient-level variables and teaching hospital status.
Collapse
Affiliation(s)
- Carlos E. Diaz-Castrillon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dustin Kliner
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - AJ Conrad Smith
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hemal Gada
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amber Makani
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Irsa Hasan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Ahmad D, Sá MP, Brown JA, Yousef S, Wang Y, Serna-Gallegos D, West D, Yoon P, Kaczorowski D, Bonatti J, Chu D, Ferdinand FD, Phillippi J, Sultan I. Hospital Teaching Status and Outcomes in Type B Aortic Dissection: Analysis of More Than 40,000 Patients. J Cardiothorac Vasc Anesth 2025; 39:88-94. [PMID: 39532660 DOI: 10.1053/j.jvca.2024.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 10/15/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE To assess the association of hospital teaching status with outcomes of patients presenting with type B aortic dissection (TBAD). DESIGN Retrospective cross-sectional study of the National Readmissions Database (NRD), from 2016 to 2020. SETTING Hospitals across the United States stratified by teaching status. PARTICIPANTS TBAD patients. INTERVENTIONS Surgical repair, thoracic endovascular aortic repair (TEVAR), and conservative medical management. MEASUREMENTS AND MAIN RESULTS A total of 44,981 TBAD patients were included, of whom 5421 (12%) were managed at a nonteaching (NT) hospital and 39,470 (88%) were treated at a teaching (T) hospital. Propensity score matching (1:1) yielded 4676 matched pairs. In-hospital mortality (12.9% for NT vs 12.5% for T; p = 0.58) and 30-day readmission (23.3% for NT vs 21.8% for T; p = 0.12) outcomes were not statistically significantly different between the groups. On multivariable regression, teaching status was not associated with higher odds of in-hospital mortality (odds ratio [OR], 0.943; 95% confidence interval [CI, 0.841-1.057; p = 0.31) or 30-day readmission (OR, 0.965; 95% CI, 0.88-1.058; p = 0.44). At teaching hospitals, TEVAR was associated with higher odds of in-hospital mortality (OR, 1.898; 95% CI, 1.596-2.257; p < .01), while hospital volume was associated with higher odds of 30-day readmission (quartile 3: OR, 1.488; 95% CI, 1.106-2.002; quartile 4: OR, 1.684; 95% CI, 1.256-2.257; p < 0.01). CONCLUSIONS Hospital teaching status alone was not associated with in-hospital mortality or 30-day readmission in TBAD patients. At teaching hospitals, management by TEVAR and greater hospital volume were associated with in-hospital mortality and 30-day readmission outcome, respectively.
Collapse
Affiliation(s)
- Danial Ahmad
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michel Pompeu Sá
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David West
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Pyongsoo Yoon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Johannes Bonatti
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Francis D Ferdinand
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Julie Phillippi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
| |
Collapse
|
3
|
Ogami T, Yousef S, Brown JA, Kliner DE, Toma C, Serna-Gallegos D, Doshi N, Wang Y, Sultan I. Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:16-20. [PMID: 38233251 DOI: 10.1016/j.carrev.2024.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves (BAV). We aimed to compare outcomes during readmissions in elderly patients with BAV who underwent SAVR or TAVR. METHODS Patients 65 years or older with BAV who underwent TAVR or isolated SAVR were identified using the National Readmission Database from 2012 through 2018. We compared outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline differences. RESULTS During the study period, 8555 and 1081 elderly patients with BAV underwent SAVR and TAVR, respectively. The number of patients who underwent TAVR went up by 179 % from 2012 to 2018. Propensity score matching yielded 573 patients in each group. A total of 111 (19.4 %) in the SAVR group and 125 (21.8 %) in the TAVR group were readmitted within 90 days after the index surgery (p = .31). The mortality during the readmissions within 90 days was equivalent between the two groups (0.9 % in the SAVR group vs. 3.2 % in the TAVR group, p = .22). However, the median hospital cost was approximately doubled in the TAVR group during the readmission (18,250 dollars vs. 9310 dollars in the SAVR group, p < .001). CONCLUSIONS Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group.
Collapse
Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nandini Doshi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
4
|
Imamura T. Prognostic impact of institutional teaching status following TAVR. J Card Surg 2022; 37:5696. [PMID: 36208101 DOI: 10.1111/jocs.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|