Objectives: To explore the impact of post-procedure delirium on resource utilization following transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively).Background: Postprocedure delirium is associated with worse long-term survival after TAVR and SAVR. However, its effect on resource utilization has been understudied.Methods: Using the 2015 Medicare Provider Analysis and Review File (MedPAR), we retrospectively analyzed elderly (≥80 years) Medicare beneficiaries receiving either SAVR or endovascular TAVR in the United States. Multivariate regression models estimating hospitalization cost and length of stay (LoS) were adjusted for patient demographics, comorbidities, and nondelirium complications.Results: A total of 21,088 discharges were available for analysis (12,114 TAVR and 8,974 SAVR).TAVR patients were older (87 AE 3.8 vs. 84 AE 2.7 years; P < 0.001) with a higher comorbidity burden (Charlson index 3.0 AE 1.8 vs. 2.1 AE 1.7; P < 0.0001). Despite this, fewer TAVR patients (1.6%) experienced postoperative delirium during the index hospitalization compared to surgical patients (3.6%; P < 0.
Background: Index hospital costs for transcatheter aortic valve replacement (TAVR) remain high. Next-day discharge (NDD) is a safe and feasible strategy in select patients. We sought to explore cost savings associated with NDD TAVR. Methods: We conducted a retrospective observation cohort study of all fee-for-service Medicare beneficiaries who underwent elective, uncomplicated, transfemoral TAVR in 2016. We employed a cross-sectional regression analysis to estimate risk-adjusted hospital costs savings of NDD relative to longer length of stay (LOS), and logistic regression to determine differences in direct home discharge and readmission. Results: Among 14,765 patients (59.2% of all TAVR), 2,169 (14.7%) were identified as NDD. They were younger (81.3 vs. 82.2, p < 0.01), more likely to be male (63% vs. 52%, p < 0.01), and had lower Charlson Comorbidity Index scores (2.73 vs. 2.98, p < 0.01).
Background:
In patients with severe aortic stenosis, treatment with transcatheter aortic valve replacement (TAVR) has been shown to be cost-effective in the high-risk surgical population and cost-saving in the intermediate-risk population when compared with surgical aortic valve replacement (SAVR) in early pivotal clinical trials. Whether TAVR is associated with comparable or lower costs when compared with SAVR in contemporary clinical practice is unknown.
Methods:
Using data from the Medicare Dataset Standard Analytic Files 5% Fee for Service database, patients receiving either TAVR or SAVR between 2016 and 2018 were identified. Patients were categorized as low, intermediate, or high mortality risk based on 2 validated indices—the Hospital Frailty Risk Score and the logEuroScore. Health care costs out to 1 year were compared between TAVR and SAVR among the low, intermediate, and high-risk groups, after adjustment for patient demographics.
Results:
Nine thousand seven hundred forty-six patients were identified (4834 TAVR; 3760 SAVR) and included in the analysis. Patients receiving TAVR were older and more likely to be female. Index hospitalization costs were significantly lower with TAVR compared with SAVR across all risk strata (logEuroScore: low: $61 845 versus $68 986; intermediate: $64 658 versus $76 965; high: $65 594 versus $91 005;
P
<0.001 for all). Follow-up costs through 1 year were generally lower with TAVR and this difference was more pronounced in the low risk groups (logEuroScore: $9763 versus $14 073; Hospital Frailty Risk Score: $10 116 versus $12 880). Accordingly, cumulative 1-year costs were substantially lower with TAVR compared with SAVR.
Conclusions:
At 1 year, TAVR is associated with lower health care costs across all risk strata when compared with SAVR in contemporary practice. If long-term data continue to demonstrate similar clinical outcomes and valve durability with TAVR and SAVR, these findings suggest that TAVR may be the preferred treatment strategy for patients with aortic stenosis from an economic standpoint.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.