MercyOne North Iowa Medical Center, Mason City, Iowa, USA.
Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
J Cardiovasc Electrophysiol. 2021 Nov;32(11):2961-2970. doi: 10.1111/jce.15247. Epub 2021 Sep 21.
Left atrial appendage occlusion (LAAO) devices have become a favorable alternative option among nonvalvular atrial fibrillation (AF) patients with long-term contraindication to anticoagulation. Real-world experience with postprocedural readmission rates and predictors of readmission in LAAO patients is limited.
To assess all-cause 30-day readmission rate and predictors of readmission after LAAO procedure in the United States.
This retrospective observational study included all AF patients undergoing percutaneous LAAO procedures in the United States from January 1, 2016, and December 31, 2017, in the National Readmission Database. The primary outcome measure was all-cause 30-day readmission. A propensity score-matched analysis compared outcomes with a non-LAAO AF cohort.
Among 14 024 LAAO procedures (age: 76 ± 8 years; 60.5% males), 9.4% were readmitted within 30-days and, 0.2% died during their index hospitalization. The most frequent primary diagnosis during readmission among LAAO was gastrointestinal bleeding (12%). The incidence of LAAO procedures increased by 102%. In the multivariate model, gender and CHA DS -VASc failed to predict readmission. Age 55-64 years had lower odds (adjusted odds ratios [aOR]: 0.41; 95% confidence interval [CI]: 0.18-0.94), while drug abuse (aOR: 4.1; 95% CI: 1.34-12.54), and deficiency anemia (aOR: 1.88; 95% CI: 1.12-3.18) had higher odds of readmission. In propensity-matched cohort, compared to non-LAAO AF, LAAO patients had lower 30-day readmission (9.4% vs. 10.98%, p = .002) and all-cause in-hospital mortality (0.19% vs. 0.57%, p < .001).
The readmission rate following the LAAO procedure is substantial (approximately 10%), and largely attributable to gastrointestinal bleeding. Factors such as drug abuse and anemia must be explored further to minimize readmission risk.
左心耳封堵（LAAO）装置已成为伴有长期抗凝禁忌的非瓣膜性心房颤动（AF）患者的一种有利的替代选择。在 LAAO 患者中，关于术后再入院率和再入院预测因素的真实世界经验有限。
评估美国 LAAO 术后 30 天全因再入院率和再入院预测因素。
本回顾性观察性研究纳入了 2016 年 1 月 1 日至 2017 年 12 月 31 日期间在美国全国再入院数据库中接受经皮 LAAO 手术的所有 AF 患者。主要观察终点为全因 30 天再入院率。采用倾向评分匹配分析比较了 LAAO 组与非 LAAO-AF 组的结果。
在 14024 例 LAAO 手术中（年龄：76±8 岁；60.5%为男性），9.4%的患者在 30 天内再入院，0.2%的患者在住院期间死亡。LAAO 再入院患者中最常见的主要诊断是胃肠道出血（12%）。LAAO 手术的发生率增加了 102%。多变量模型显示，性别和 CHA2DS2-VASc 评分不能预测再入院。55-64 岁年龄组的再入院几率较低（调整后的比值比[OR]：0.41；95%置信区间[CI]：0.18-0.94），而药物滥用（OR：4.1；95%CI：1.34-12.54）和缺铁性贫血（OR：1.88；95%CI：1.12-3.18）的再入院几率较高。在倾向评分匹配队列中，与非 LAAO-AF 相比，LAAO 患者的 30 天再入院率（9.4% vs. 10.98%，p=0.002）和全因院内死亡率（0.19% vs. 0.57%，p<0.001）均较低。
LAAO 术后的再入院率相当高（约 10%），主要归因于胃肠道出血。必须进一步探讨药物滥用和贫血等因素，以降低再入院风险。
