Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample

Telila, Tesfaye; Akintoye, Emmanuel; Ando, Tomo; Merid, Obsinet; Palla, Mohan; Mallikethi-Reddy, Sagar; Briasoulis, Αlexandros; Grines, Cindy L.; Afonso, Luís

doi:10.1002/ccd.27236

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Despite the absence of similar studies for comparison, our results are in line with very few previous reports that demonstrate increased in-hospital mortality following procedures performed in academic settings (e.g., endoscopic retrograde cholangiopancreatography) [1] and contradict others that showed no difference (e.g. transcatheter aortic valve replacement) [2] or even improved outcomes (e.g. percutaneous coronary intervention, coronary artery bypass graft) [17,18] in patients undergoing procedures at teaching hospitals.…”

Section: Inpatient Mortality In Teaching Hospitalssupporting

confidence: 90%

“…On the other hand, patients admitted to nonteaching hospitals are usually taken care of by a clinician or provider that is not a trainee. As a result of the theory that training settings carry higher risks of complications and adverse outcomes for patients, secondary to trainees' inexperience, researchers have long attempted to determine whether medical teaching environments have a significant impact on various patient outcomes than non-teaching settings [1][2][3]. However, the results are not consistent with a specific pattern of patient benefits [4][5][6] or harms [3,7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample

Aldiabat¹,

Aljabiri²,

Al-Khateeb³

et al. 2022

Cureus

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Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. However, the impact of teaching hospital status on outcomes of percutaneous paracentesis, to the best of our knowledge, has never been studied before. MethodsHospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database from 2016 to 2019 across the United States (US) teaching and non-teaching hospitals. Outcomes studied were differences in risk of mortality, postprocedural outcomes, and healthcare resource utilization. Multivariate logistic analysis was performed using STATA software (StataCorp LLC, College Station, Texas, US) and results were adjusted for patient and hospital characteristics and comorbidities. ResultsInpatient mortality rates were significantly higher in patients undergoing paracentesis at US teaching hospitals (adjusted odds ratio (aOR) 1.29, 95%CI 1.23-1.35, p<0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95%CI 1.65-2.20, p<0.001), hollow viscus perforation (aOR 1.97, 95%CI 1.54-2.51, p<0.001), and vessel injury/laceration (aOR 15.3, 95%CI 2.12-110.2, p=0.007) were noticed in the study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95%CI 1. 68-1.94, p<0.001

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Section: Inpatient Mortality In Teaching Hospitalssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample

Aldiabat¹,

Aljabiri²,

Al-Khateeb³

et al. 2022

Cureus

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“…1 Thus far, no difference in mortality has been demonstrated between nonteaching and teaching hospitals. 8,9 In the present study, the unadjusted increased in-hospital mortality in teaching hospital reflects the higher preprocedure comorbidities and postprocedure complications rates since after adjustment of these variables, there was no longer a significant difference in mortality between nonteaching and teaching hospitals. Therefore, results suggest underlying health characteristics contribute to mortality rather than hospital teaching status.…”

Section: Mortalitymentioning

confidence: 47%

Outcomes of transcatheter aortic valve replacement at teaching versus nonteaching hospitals

Hasan

Brown

Aranda‐Michel

et al. 2022

Journal of Cardiac Surgery

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Introduction: Prior studies have demonstrated that outcomes of invasive cardiac interventions may vary by hospital teaching status and volume. As transcatheter aortic valve replacement (TAVR) rapidly expands from teaching to nonteaching hospitals across the country, the clinical impact of hospital teaching status has not been clearly established. This study aimed to compare TAVR outcomes between nonteaching and teaching hospitals.Methods: An observational study was conducted using the Nationwide Readmission Database (NRD). Patients undergoing TAVR from 2011 to 2018 were included. Data was analyzed using multivariable logistic regression to determine outcomes of 30day mortality and readmission between nonteaching and teaching hospitals.Results: A total of 235,321 patients underwent TAVR during the study period.Patients undergoing TAVR at teaching hospitals presented with a higher frequency of baseline comorbidities compared to nonteaching hospitals. Postprocedure complications such as myocardial infarction, arrhythmia, pneumonia, acute kidney injury, sepsis, stroke, and hemorrhage occurred more often at teaching centers (p < 0.001); translating to a higher rate of in-hospital mortality (2.27% vs. 1.99%, p = 0.006) and hospital cost ($48,300 vs. $44,900, p < 0.001) in teaching versus nonteaching hospitals. After adjusting for baseline characteristics and postoperative morbidity, in-hospital mortality (p = 0.095) and readmission rate (p = 0.420) on multivariable analysis were not statistically different between centers. Conclusion:With the evolution and expansion of TAVR to nonteaching centers, mortality, and readmission rates are not significantly different between nonteaching and teaching hospitals. Higher unadjusted in-hospital mortality at teaching centers suggest these centers more often treat high risk patients with associated increased complications.

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“…According to the 2016 Annual report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, number of TAVR performed was 4,627 in 2012 but almost increased by 6‐folds up to 24,808 in 2015 with decline in in‐hospital mortality from 5.9% in 2012 to 2.9% in 2015 . With its expansion in utilization as a major treatment modality for severe, symptomatic aortic stenosis, the number of TAVR performed at non‐teaching hospitals also increased from only 3.6% in 2011 to 8 to 10% in 2012 to 2014 …”

Section: Introductionmentioning

confidence: 99%

“…According to these studies, bleeding, new dialysis, respiratory complications, conversion to open‐heart surgery occurred more frequently in non‐teaching hospital whereas use of mechanical circulatory support was less in the teaching hospitals . In addition, while TAVR morbidity and mortality were about the same between teaching and non‐teaching hospitals, SAVR outcomes at non‐teaching hospitals showed more detrimental outcomes as compared with teaching hospital . Therefore, there could be a difference in comparative outcomes between TAVR vs. SAVR in non‐teaching hospitals.…”

Section: Introductionmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non‐teaching hospitals. Background TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non‐teaching hospitals are largely under explored. Methods We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans‐arterial TAVR or SAVR at non‐teaching hospital. In‐hospital clinical outcomes were compared with odds ratio (OR) in propensity‐matched cohorts. Results We identified un‐weighted 957 and 7,465 SAVR admissions. In propensity‐matched model, 596 admissions in each arm were included for final analysis. In‐patient mortality (3.9 vs. 2.5%, OR 1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.0 vs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar between TAVR and SAVR. Sub‐group analysis showed that female and those with prior coronary artery bypass surgery had higher risk of in‐patient morality in TAVR admission. Cost was higher (59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days, P < 0.001). Conclusions TAVR conferred similar in‐hospital mortality and major peri‐procedural complications compared with SAVR in non‐teaching hospitals. For those with limited access to teaching hospitals, non‐teaching hospitals appear to be a reasonable option for candidates of aortic valve replacement for severe aortic stenosis.

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Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample

Cited by 9 publications

References 16 publications

Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample

Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample

Outcomes of transcatheter aortic valve replacement at teaching versus nonteaching hospitals

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

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