Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga; Cardiology Department, Université de Montréal, Montréal, Québec, Canada.
Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga.
J Thorac Cardiovasc Surg. 2017 Aug;154(2):445-452. doi: 10.1016/j.jtcvs.2017.03.144. Epub 2017 Apr 18.
OBJECTIVE: In high- or extreme-risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30-day and 1-year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1-year mortality. METHODS: A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University. RESULTS: Patients' median age was 83 years, and 46.6% were female. Early all-cause readmission for the cohort was 10.5%, and late readmission was 18.8%. Anemia was related to both early all-cause (hazard ratio [HR], 0.74) and cardiovascular-related readmission (HR, 0.60). A 23-mm valve implanted was associated with early all-cause readmission (HR, 1.73). Length of hospital stay was related to late all-cause (HR, 1.14) and cardiovascular-related readmission (HR, 1.21). Postoperative permanent stroke had an impact on late cardiovascular-related readmission (HR, 3.60; 95% confidence interval, 1.13-11.49). Multivariable analysis identified anemia as being associated with 30-day all-cause readmission, and anemia and postoperative stroke were associated with 30-day cardiovascular-related readmission. Readmissions seemed to be related to 1-year mortality (HR, 2.04; 95% confidence interval, 1.33-3.12). CONCLUSIONS: We show some baseline comorbidities and procedural complications that are directly associated with early and late readmissions, and anemia and postoperative stroke were associated with an increase in mortality. Moreover, we found that readmission was associated with double the hazard of death within 1 year. Whether treatment of identified risk factors could decrease readmission rates and mortality warrants further investigation.
目的:在接受经导管主动脉瓣置换术的高危或极高危患者中,再入院情况尚未得到充分研究,并且越来越受到医疗保健系统的关注。本研究的目的是确定 30 天和 1 年心脏和非心脏再入院的发生率,确定再入院的预测因素,并评估再入院与 1 年死亡率之间的关系。
方法:对 2007 年 9 月至 2015 年 1 月在埃默里大学接受经导管主动脉瓣置换术的 714 例患者进行回顾性分析。
结果:患者的中位年龄为 83 岁,46.6%为女性。该队列的早期全因再入院率为 10.5%,晚期再入院率为 18.8%。贫血与早期全因(危险比 [HR],0.74)和心血管相关再入院(HR,0.60)均相关。植入 23mm 瓣膜与早期全因再入院相关(HR,1.73)。住院时间与晚期全因(HR,1.14)和心血管相关再入院(HR,1.21)相关。术后永久性中风对晚期心血管相关再入院有影响(HR,3.60;95%置信区间,1.13-11.49)。多变量分析确定贫血与 30 天全因再入院相关,贫血和术后中风与 30 天心血管相关再入院相关。再入院似乎与 1 年死亡率相关(HR,2.04;95%置信区间,1.33-3.12)。
结论:我们发现一些基线合并症和手术并发症与早期和晚期再入院直接相关,贫血和术后中风与死亡率增加相关。此外,我们发现再入院使 1 年内死亡的风险增加了两倍。是否治疗确定的危险因素可以降低再入院率和死亡率,这值得进一步研究。