Factors associated with length of stay following trans-catheter aortic valve replacement - a multicenter study

Abstract

BackgroundMost patients undergoing Transcatheter aortic valve implantation (TAVR) are elderly with significant co-morbidities and there is limited information available regarding factors that influence length of stay (LOS) post-procedure. The aim of this study was to identify the patient, and procedural factors that affect post-TAVR LOS using a contemporary multinational registry.MethodsWe conducted a retrospective cohort study, with patients recruited from three high volume tertiary institutions. The primary outcome was the LOS post-TAVR procedure. We examined patient and procedural factors in a cause-specific Cox multivariable regression model to elucidate their effect on LOS, accounting for the competing risk of post-procedural death. Hazard ratios (HR) greater than 1 indicate a shorter LOS, while HRs less than 1 indicate a longer LOS.ResultsThe cohort consisted of 809 patients. Patient factors associated with longer LOS were older age, prior atrial fibrillation, and greater patient urgency. Patient factors associated with shorter LOS were lower NYHA class, higher ejection fraction and higher mean aortic valve gradients.Procedural characteristics associated with shorter LOS were conscious sedation (HR = 1.19, 95% CI 1.06–1.35, p = 0.004). Transapical access was associated with prolonged LOS (HR = 0.49, 95% CI 0.41–0.58, p < 0.001).ConclusionThis multicenter study identified potentially modifiable patient and procedural factors associated with a prolonged LOS. Future research is needed to determine if interventions focused on these factors will translate to a shorter LOS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0573-7) contains supplementary material, which is available to authorized users.

Transcatheter aortic valve replacement- management of patients with significant coronary artery disease undergoing aortic valve interventions: surgical compared to catheter-based approaches in hybrid procedures

“…However, this may be explained by the fact that baseline EuroSCORE and NYHA class, two factors identified as predictive for length of hospital stay after TAVR in clinical practice [18], were fairly comparable between TAVR groups. The ubiquitous use of general anaesthesia, despite PCI and TF-TAVR being feasible under conscious sedation, may also have contributed [21]. Nevertheless, there appears to be scope for further exploitation of early discharge after fully percutaneous hybrid procedures.…”

Clinical Process Optimization of Transfemoral Transcatheter Aortic Valve Implantation

“…Prolonged inpatient stays have already been shown to be associated with a higher risk of nosocomial infections, including pneumonia and urinary tract infections [3][4][5] and subsequent utilization of healthcare resources, as well as associated cost of care for the healthcare provider [6][7][8]. While some factors, such as patient age and severity of disease, were observed as independent predictors of prolonged hospital stays in patients undergoing TAVI [9], no model for the optimization of the inner clinical processing in TAVI exists so far. In contrast to most cardiologic diseases, TAVI is a mostly electively planned procedure and therefore offers the opportunity for planned processing.…”

Trends and effect of atrial fibrillation on inpatient outcomes after transcatheter aortic valve replacement

“…Patients with AF were also more likely to have an increased LOS after TAVR and be discharged to a skilled nursing facility. The association between pre-existing AF with a longer LOS has been previously investigated (16). In another study of 663 patients undergoing elective TAVR, the absence of AF was predictive of next-day discharge after TAVR (17).…”