Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.
Department of Medicine, Rochester General Hospital, Rochester, New York, USA.
Catheter Cardiovasc Interv. 2021 Aug 1;98(2):343-351. doi: 10.1002/ccd.29517. Epub 2021 Feb 1.
To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end-stage renal disease (ESRD).
Renal disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr.
We analyzed NIS data from January 2010 to December 2017 using the ICD-9-CM codes ICD-10-CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒 test for categorical variables and independent samples t-test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values.
A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in-hospital mortality was lower in non-ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non-home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503).
ESRD is associated with higher mortality, complications, and resource utilization compared to non-ESRD patients. It is important to include this data in shared decision-making process and patient selection.
研究终末期肾病（ESRD）患者行经导管二尖瓣修复术（TMVr）的利用情况、结局和医疗费用趋势。
肾脏疾病已知是二尖瓣疾病患者预后不良的预测因素。ESRD 患者行 TMVr 的结局数据仍然有限。因此，我们的研究旨在调查 ESRD 患者行 TMVr 的利用情况、结局和医疗费用趋势。
我们使用 ICD-9-CM 代码和 ICD-10-CM 分析了 2010 年 1 月至 2017 年 12 月的 NIS 数据，以识别接受 TMVr 的患者。使用 Pearson 𝜒 检验比较分类变量的基线特征，使用独立样本 t 检验比较连续变量的基线特征。使用倾向评分匹配分析进行调整分析，以比较 TMVr 伴和不伴 ESRD 的结局。使用马尔可夫链蒙特卡罗法处理缺失值。
在 2010 年至 2017 年期间，共确定了 15260 名（加权样本）接受 TMVr 的患者。其中，638 名患者患有 ESRD，而 14631 名患者没有 ESRD。非 ESRD 组的院内调整死亡率较低（3.9% vs. <1.8%）。同样，ESRD 患者更有可能非家庭出院（85.6% vs. 74.9%）。ESRD 患者的平均住院时间也更长（7.9 天 vs. 13.5 天），平均住院费用也更高（306300 美元 vs. 271503 美元）。
与非 ESRD 患者相比，ESRD 患者的死亡率、并发症和资源利用率更高。在决策过程和患者选择中纳入这些数据非常重要。
