Dhoble Abhijeet, Peerbhai Shareez, Zhao Yelin, Vejpongsa Pimprapa, Garcia-Sayan Enrique, Smalling Richard W, Estrera Anthony, Nguyen Tom C
Division of Cardiovascular Medicine, University of Texas McGovern School of Medicine, Houston, Texas.
Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas.
J Card Surg. 2020 Aug;35(8):1848-1855. doi: 10.1111/jocs.14729. Epub 2020 Jul 11.
The data on readmissions following tricuspid valve repair/replacement (TVR) are scarce. We examined rates, predictors, causes, and outcomes of readmissions after TVR, using the National Readmission Database.
The International Classification of Diseases-9th version was used to identify the patients who underwent isolated TVR or concomitant aortic, mitral, and coronary bypass surgeries. Rates, causes, and outcomes were assessed using the analysis of variance and the χ test, and predictors of readmissions were evaluated using multivariate analysis.
A total of 8254 patients who underwent TVR during 2013 to 2014 were included, of whom 1994 (24.16%) were isolated, and 6260 (75.84%) were performed concomitantly with other heart valve or coronary bypass surgery. A total of 1720 (20.84%) patients were readmitted within 30 days. The readmission rates were 448 (22.46%) after isolated TVR and similar after concomitant TVR (TVR + aortic valve replacement, TVR + mitral valve repair, TVR + coronary artery bypass graft, and TVR + multiple) (P = .194); whereas 1305 (20.11%) and 414 (23.45%) were after tricuspid valve repair and replacement (P = .080), respectively. The independent predictors of readmission were acute kidney injury during index visit and Charlson comorbidity index of more than 2. Mean time to readmission and median length of stay during readmission were 13.02 (±7.93) and 5 (interquartile range: 3-9) days, respectively. Total mortality during rehospitalization was 105 (6.1%), a very high (26.86%) number of patients were discharged to skilled facilities after readmission.
One out of five patients were readmitted within 30 days after the TVR, associated with 6.1% mortality during rehospitalization, and very high need for skilled facility placement.
三尖瓣修复/置换术后再入院的数据很少。我们使用国家再入院数据库研究了三尖瓣修复/置换术后再入院的发生率、预测因素、原因及结局。
采用国际疾病分类第九版来确定接受单纯三尖瓣修复/置换术或同时进行主动脉、二尖瓣和冠状动脉搭桥手术的患者。使用方差分析和χ检验评估发生率、原因及结局，通过多变量分析评估再入院的预测因素。
纳入了2013年至2014年期间接受三尖瓣修复/置换术的8254例患者，其中1994例（24.16%）为单纯手术，6260例（75.84%）同时进行了其他心脏瓣膜或冠状动脉搭桥手术。共有1720例（20.84%）患者在30天内再次入院。单纯三尖瓣修复/置换术后再入院率为448例（22.46%），同时进行三尖瓣修复/置换术（三尖瓣修复/置换术+主动脉瓣置换、三尖瓣修复/置换术+二尖瓣修复、三尖瓣修复/置换术+冠状动脉搭桥术和三尖瓣修复/置换术+多种手术）后的再入院率相似（P = 0.194）；而三尖瓣修复和置换术后分别为1305例（20.11%）和414例（23.45%）（P = 0.080）。再入院的独立预测因素为首次就诊时的急性肾损伤和Charlson合并症指数大于2。再次入院的平均时间和住院时间中位数分别为13.02（±7.93）天和5天（四分位间距：3 - 9天）。再次住院期间的总死亡率为105例（6.1%），很高比例（26.86%）的患者在再次入院后被转至专业护理机构。
五分之一的患者在三尖瓣修复/置换术后30天内再次入院，再次住院期间死亡率为6.1%，且对转至专业护理机构的需求非常高。
