Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
Eur J Health Econ. 2018 Mar;19(2):223-228. doi: 10.1007/s10198-017-0877-7. Epub 2017 Feb 22.
The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified.
In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses.
A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment.
Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.
经导管主动脉瓣植入术（TAVI）后各种术后并发症对资源利用的影响及其在德国报销系统中的后果仍未得到充分量化。
在一项回顾性观察研究中，我们使用了德国 DRG 统计数据中 2013 年所有孤立性 TAVI 手术的患者特征和住院期间结局的数据（N=9147）。使用未调整和风险调整的线性和逻辑回归分析，分析了术后并发症对报销、住院时间和机械通气的影响。
共记录了 235 例（2.57%）中风、583 例（6.37%）出血事件、474 例（5.18%）急性肾损伤和 1428 例（15.61%）起搏器植入。未经并发症治疗的 TAVI 手术的预测报销金额为 33272 欧元，出血事件与最高额外报销（12839 欧元，p<0.001）、额外住院时间（14.58 天，p<0.001）和机械通气超过 48 小时的可能性增加（OR 17.91，p<0.001）相关。发现急性肾损伤（额外报销：5963 欧元，p<0.001；额外住院时间：7.92 天，p<0.001；通气>48 小时：OR 6.93，p<0.001）以及中风（额外报销：4125 欧元，p<0.001；额外住院时间：4.68 天，p<0.001；通气>48 小时：OR 5.73，p<0.001）对资源利用和报销的影响相对适中。相比之下，起搏器植入与报销（662 欧元，p=0.006）和住院时间（3.54 天，p=0.006）的适度增加以及机械通气超过 48 小时的可能性没有降低（OR 1.22，p=0.156）相关。有趣的是，这些与并发症相关的后果在基线风险调整后基本保持不变。
出血事件、急性肾损伤和中风等术后并发症与德国资源利用增加和大量额外报销相关，这对临床常规范围之外的决策具有重要意义。
