Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, NY.
J Am Heart Assoc. 2017 Aug 21;6(8):e006127. doi: 10.1161/JAHA.117.006127.
Nearly 17% of patients are readmitted within 30 days of discharge after transcatheter aortic valve replacement. Selected patients are discharged to skilled nursing facilities, yet the association between a hospital's practice to discharge home versus to skilled nursing facilities, and readmission remains unclear.
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry was used to evaluate readmissions among patients undergoing transcatheter aortic valve replacement (2011-2015). Hospitals were divided into quartiles (Q1-Q4) based on the percentage of patients discharged directly home. We assessed patient and hospital level characteristics and used hierarchical logistic regression to analyze the association of discharge disposition with 30-day readmission. Our cohort included 18 568 transcatheter aortic valve replacement patients at 329 US hospitals, of whom 69% were discharged directly home. Hospitals in the highest quartile of direct home discharge (Q4) compared with hospitals in the lowest (Q1) were more likely to use femoral access (75.2% versus 60.1%, <0.001), had fewer patients receiving transfusion (26.4% versus 40.9%, <0.001), and were more likely to be located in the Southern United States (48.8% versus 18.3%, <0.001). Median 30-day readmission rate was 17.9%. There was no significant difference in 30-day readmissions among quartiles (=0.14), even after multivariable adjustment (odds ratio Q4 versus Q1=0.89, 95%CI 0.76-1.04; =0.15). Factors most strongly associated with 30-day readmission were glomerular filtration rate, in-hospital stroke or transient ischemic attack, and nonfemoral access.
There was no statistically significant association between hospital practice of direct home discharge post-transcatheter aortic valve replacement and 30-day readmission. Further research is needed to understand regional variations and optimum strategies for postdischarge care.
经导管主动脉瓣置换术后，近 17%的患者在出院后 30 天内再次入院。部分患者出院至护理院，但医院将患者出院至家中与护理院的做法与再入院之间的关系尚不清楚。
使用胸外科医师学会/美国心脏病学会经导管瓣膜治疗（STS/ACC TVT）登记处评估了 2011 年至 2015 年期间接受经导管主动脉瓣置换术的患者的再入院情况。根据直接出院回家的患者比例，将医院分为四分位（Q1-Q4）。我们评估了患者和医院的水平特征，并使用分层逻辑回归分析出院处置与 30 天再入院的关系。我们的队列包括来自美国 329 家医院的 18568 例经导管主动脉瓣置换术患者，其中 69%直接出院回家。与最低四分位（Q1）相比，最高四分位（Q4）的直接出院回家的医院更有可能使用股动脉入路（75.2%比 60.1%，<0.001），接受输血的患者更少（26.4%比 40.9%，<0.001），并且更可能位于美国南部（48.8%比 18.3%，<0.001）。中位 30 天再入院率为 17.9%。四分位之间的 30 天再入院率无显著差异（=0.14），即使在多变量调整后（Q4 与 Q1 的比值比为 0.89，95%CI 0.76-1.04；=0.15）。与 30 天再入院最相关的因素是肾小球滤过率、院内卒中和短暂性脑缺血发作以及非股动脉入路。
经导管主动脉瓣置换术后，医院直接出院回家的做法与 30 天再入院之间无统计学显著关联。需要进一步研究以了解区域差异和出院后护理的最佳策略。
