Wayne State University/Detroit Medical Center, Detroit, Michigan.
Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey.
Am J Cardiol. 2019 Apr 1;123(7):1142-1148. doi: 10.1016/j.amjcard.2018.12.044. Epub 2019 Jan 8.
We aimed to identify risk factors of high hospitalization cost after transcatheter aortic valve implantation (TAVI). TAVI expenditure is generally higher compared with surgical aortic valve replacement. We queried the Nationwide Inpatient Sample database from January 2011 to September 2015 to identify those who underwent endovascular TAVI. Estimated cost of hospitalization was calculated by merging the Nationwide Inpatient Sample database with cost-to-charge ratios available from the Healthcare Cost and Utilization Project. Patients were divided into quartiles (lowest, medium, high, and highest) according to the hospitalization cost, and multivariable regression analysis was performed to identify patient characteristics and periprocedural complications associated with the highest cost group. A total of 9,601 TAVI hospitalizations were identified. Median in-hospital costs of the highest and lowest groups were $82,068 and $33,966, respectively. Patients in the highest cost group were older and more likely women compared with the lowest cost group. Complication rates (68.4% vs 22.5%) and length of stay (median 10 days vs 3 days) were both approximately 3 times higher and longer, respectively, in the highest cost group. Co-morbidities such as heart failure, peripheral vascular disease, atrial fibrillation, anemia, and chronic dialysis as well as almost all complications were associated with the highest cost group. The complications with the highest incremental cost were acute respiratory failure requiring intubation ($28,209), cardiogenic shock ($22,401), and acute kidney injury ($16,974). Higher co-morbidity burden and major complications post-TAVI were associated with higher hospitalization costs. Prevention of these complications may reduce TAVI-related costs.
我们旨在确定经导管主动脉瓣植入术（TAVI）后高住院费用的风险因素。与外科主动脉瓣置换术相比，TAVI 的支出通常更高。我们从 2011 年 1 月至 2015 年 9 月查询了全国住院患者样本数据库，以确定接受血管内 TAVI 的患者。通过将全国住院患者样本数据库与医疗保健成本和利用项目中可用的费用与收费比率合并，计算出住院费用的估计值。根据住院费用将患者分为四分位数（最低、中、高和最高），并进行多变量回归分析，以确定与最高费用组相关的患者特征和围手术期并发症。共确定了 9601 例 TAVI 住院患者。最高和最低费用组的中位住院费用分别为 82068 美元和 33966 美元。与最低费用组相比，最高费用组的患者年龄更大，且女性更多。并发症发生率（68.4%比 22.5%）和住院时间（中位数为 10 天比 3 天）分别高出约 3 倍和更长。心力衰竭、外周血管疾病、心房颤动、贫血和慢性透析等合并症以及几乎所有并发症均与最高费用组相关。导致增量费用最高的并发症是需要插管的急性呼吸衰竭（28209 美元）、心源性休克（22401 美元）和急性肾损伤（16974 美元）。TAVI 后更高的合并症负担和主要并发症与更高的住院费用相关。预防这些并发症可能会降低 TAVI 相关成本。
