Outcomes of transcatheter aortic valve replacement at teaching versus nonteaching hospitals

Abstract

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.

Prognostic impact of institutional teaching status following TAVR

“…In their study, the inhospital mortality was consistently around 2.0%. 1 The current concerns are mid or long-term mortality and morbidity. Such clinical outcomes, instead of in-hospital mortality, might be significantly stratified by the teaching status (or volume status).…”

“…Several baseline characteristics were compared between the teaching and nonteaching institutes, 1 whereas other conventional parameters that should affect clinical outcomes following TAVR are not compared, including frailty status, the existence of low-flow low-gradient aortic stenosis, and severity of other valvular diseases.…”

“…To the Editor, Transcatheter aortic valve replacement (TAVR) rapidly expands from teaching to nonteaching institutes across the country, whereas the prognostic impact of teaching status (i.e., teaching vs. nonteaching) remains uncertain in the current era. Hasan et al 1 demonstrated that mortality and readmission rates were not significantly affected by the teaching status. The unadjusted in-hospital mortality was rather higher in the teaching institute, probably due to candidates with more advanced comorbidities.…”