Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR

Bendayan, Melissa; Messas, Nathan; Perrault, Louis P.; Asgar, Anita W.; Lauck, Sandra; Kim, Dae; Arora, Rakesh C.; Langlois, Yves; Piazza, Nicolò; Martucci, Giuseppe; Lefèvre, Thierry; Noiseux, Nicolas; Lamy, André; Peterson, Mark D.; Labinaz, Marino; Popma, Jeffrey J.; Webb, John G.; Afilalo, Jonathan

doi:10.1016/j.jcin.2020.01.238

Cited by 40 publications

(19 citation statements)

References 46 publications

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“…Patients who undergo TAVR are typically frail, elderly, and are at a risk for both bleeding and ischemic complications [12,15,16]. Careful risk and benefit evaluation is warranted to identify the antithrombotic regimen, as major late bleeding complications are not only frequent but also associated with an increased risk of total mortality [17]. With baseline hematological problems, higher bleeding complications related to coagulation factors and platelets were identified in our study.…”

Section: Discussionmentioning

confidence: 75%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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BackgroundTranscatheter aortic valve replacement (TAVR) is now a common procedure to treat and improve quality of life, clinical outcomes, and self-sufficiency in high-risk patients with aortic stenosis, and its use has been expanding rapidly in younger and low-risk populations. The aim of this study was to evaluate the outcomes, trends, and predictors of major bleeding in patients undergoing TAVR. MethodologyWe utilized the National Inpatient Sample (NIS) data from the year 2015 to 2018. International Classification of Disease 10 codes were utilized to extract data. Baseline characteristics were compared using Pearson's chisquare test for categorical variables and independent samples t-test for continuous variables. A multivariable logistic regression model was used to evaluate the predictors of major bleeding. Propensity matching was done for adjusted analysis to compare outcomes in TAVR with and without major bleeding. The outcomes of interest in this study were (1) predictors of major bleeding after TAVR; (2) in-hospital mortality; and (3) resource utilization in terms of cost and length of stay. ResultsA total of 34,752 weighted hospitalizations for TAVR were included in the analysis. Of the patients undergoing the procedure, 2,294 (6.6%) had a major bleed while 32,458 (93.3%) did not. At baseline, patients with coagulopathy (odds ratio [OR]: 2.03; 95% confidence interval [

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Section: Discussionmentioning

confidence: 75%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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“…Towards improving hospital care modeling for TAVR, researchers have largely examined the predictive value of traditional metrics such as age and comorbidity on TAVR outcome costs [9], and more recently frailty as a predictor of hospital stay [10][11][12]. Integrating preoperative cognitive biomarkers into the model is the next logical research approach, particularly given: (1) the abundance of research documenting the significance of preoperative cognition on postoperative outcome [6]; (2) that 54% of all surgical procedures are performed on older adults [13]; (3) prospective hospital-based studies show at least 20% of older adults electing surgical procedures have mild to moderate cognitive limitations on standardized screening metrics [14,15]; and (4) general surgery guidelines strongly recommend at minimum preoperative cognitive screening for older adults electing surgery.…”

Section: Introductionmentioning

confidence: 99%

Proof of concept: digital clock drawing behaviors prior to transcatheter aortic valve replacement may predict length of hospital stay and cost of care

Wiggins

Dion

Formanski

et al. 2021

Exploration of Medicine

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Aims: Reduced pre-operative cognitive functioning in older adults is a risk factor for postoperative complications, but it is unknown if preoperative digitally-acquired clock drawing test (CDT) cognitive screening variables, which allow for more nuanced examination of patient performance, may predict lengthier hospital stay and greater cost of hospital care. This issue is particularly relevant for older adults undergoing transcatheter aortic valve replacement (TAVR), as this surgical procedure is chosen for intermediate-risk older adults needing aortic replacement. This proof of concept research explored if specific latency and graphomotor variables indicative of planning from digitally-acquired command and copy clock drawing would predict post-TAVR duration and cost of hospitalization, over and above age, education, American Society of Anesthesiologists (ASA) physical status classification score, and frailty. Methods: Form January 2018 to December 2019, 162 out of 190 individuals electing TAVR completed digital clock drawing as part of a hospital wide cognitive screening program. Separate hierarchical regressions were computed for the command and copy conditions of the CDT and assessed how a-priori selected clock drawing metrics (total time to completion, ideal digit placement difference, and hour hand distance from center; included within the same block) incrementally predicted outcome, as measured by R2 change significance values. Results: Above and beyond age, education, ASA physical status classification score, and frailty, only digitally-acquired CDT copy performance explained significant variance for length of hospital stay (9.5%) and cost of care (8.9%). Conclusions: Digital variables from clock copy condition provided predictive value over common demographic and comorbidity variables. We hypothesize this is due to the sensitivity of the copy condition to executive dysfunction, as has been shown in previous studies for subtypes of cognitive impairment. Individuals undergoing TAVR procedures are often frail and executively compromised due to their cerebrovascular disease. We encourage additional research on the value of digitally-acquired clock drawing within different surgery types. Type of cognitive impairment and the value of digitally-acquired CDT command and copy parameters in other surgeries remain unknown.

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“…In general, the state of nutritional deficiency in a frail patient impedes the calorically taxing processes involved in post-surgical recovery [34][35][36]. Protein and energy insufficiency impairs proper wound healing, coagulation, and immunological defenses, which elevates the risk of infection and bleeding [37,38]. Decreased energy stores also depress neural drive and muscular strength, both of which may contribute to deterioration in diaphragmatic function and ultimately to post-procedural respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

The clinical impact of frailty on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: a propensity-score matched database study

et al. 2021

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Background Frailty aggregates a composite of geriatric and elderly features that is classified into a singular syndrome; literature thus far has proven its influence over postoperative outcomes. In this study, we evaluate the effects of frailty following gastrectomy for gastric cancer. Methods 2011-2017 National Inpatient Sample was used to isolate patients with gastric cancer undergoing gastrectomy; from this, the Johns Hopkins ACG frailty criteria were applied to segregate frailty-present and absent populations. The case-controls were matched using propensity-score matching and compared to various endpoints. Results Post match, there were 1171 with and without frailty who were undergoing gastrectomy for gastric cancer. Those with frailty had higher mortality (6.83 vs 3.50% p < 0.001, OR 2.02 95% CI 1.37-2.97), length of stay (16.7 vs 12.0d; p < 0.001), and costs ($191,418 vs $131,367; p < 0.001); frail patients also had higher rates of complications including wound complications (3.42 vs 0.

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Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR

Cited by 40 publications

References 46 publications

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Proof of concept: digital clock drawing behaviors prior to transcatheter aortic valve replacement may predict length of hospital stay and cost of care

The clinical impact of frailty on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: a propensity-score matched database study

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