美国经导管主动脉瓣置换术后30天再入院情况：来自全国再入院数据库的见解
Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.
作者信息
Kolte Dhaval, Khera Sahil, Sardar M Rizwan, Gheewala Neil, Gupta Tanush, Chatterjee Saurav, Goldsweig Andrew, Aronow Wilbert S, Fonarow Gregg C, Bhatt Deepak L, Greenbaum Adam B, Gordon Paul C, Sharaf Barry, Abbott J Dawn
机构信息
From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.).
出版信息
Circ Cardiovasc Interv. 2017 Jan;10(1). doi: 10.1161/CIRCINTERVENTIONS.116.004472.
BACKGROUND
Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited.
METHODS AND RESULTS
Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively.
CONCLUSIONS
Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
背景
心脏手术后再入院情况很常见，会导致医疗资源利用增加和成本上升。关于经导管主动脉瓣置换术（TAVR）后30天再入院的数据有限。
方法与结果
在全国再入院数据库中确定了2013年1月至11月期间接受TAVR（国际疾病分类第九版临床修正码35.05和35.06）且在首次住院中存活下来的患者。分析了30天再入院的发生率、预测因素、原因和成本。在12221例TAVR患者中，2188例（17.9%）在30天内再次入院。首次住院期间住院时间>5天（风险比[HR]，1.47；95%置信区间[CI]，1.24 - 1.73）、急性肾损伤（HR，1.23；95%CI，1.05 - 1.44）、>4种埃利克斯豪泽共病（HR，1.22；95%CI，1.03 - 1.46）、经心尖TAVR（HR，1.21；95%CI，1.05 - 1.39）、慢性肾病（HR，1.20；95%CI，1.04 - 1.39）、慢性肺病（HR，1.16；95%CI，1.01 - 1.34）以及出院至专业护理机构（HR，1.16；95%CI，1.01 - 1.34）是30天再入院的独立预测因素。61.8%的再入院病例是由于非心脏原因，38.2%是由于心脏原因。呼吸问题（14.7%）、感染（12.8%）、出血（7.6%）和外周血管疾病（4.3%）是最常见的非心脏原因，而心力衰竭（22.5%）和心律失常（6.6%）是再入院最常见的心脏原因。再入院的中位住院时间和成本分别为4天（四分位间距，2 - 7天）和8302美元（四分位间距，5229 - 16021美元）。
结论
TAVR后30天再入院很常见，且与基线共病、TAVR入路部位和术后并发症有关。了解这些预测因素有助于识别高危患者并针对性地进行干预，以减少再入院和成本。
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