Fabry Nicholas, Hendrickson Michael J, Arora Sameer, Vavalle John P
Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1251-1256. doi: 10.1002/ccd.30121. Epub 2022 Feb 19.
The study aimed to evaluate cost trends associated with mitral valve transcatheter edge-to-edge repair (TEER).
TEER is a treatment option for patients at prohibitive surgical risk with moderate to severe mitral valve regurgitation and NYHA class III or IV symptoms. The 30-day costs and causes of readmission following TEER have not been well studied.
Patients undergoing mitral TEER in the United States from 2014 to 2018 were identified in the Nationwide Readmission Database. Patient characteristics, cause-specific readmission, and costs of the index hospitalization and readmissions were analyzed. Costs were trended over years using general linear regression.
A total of 10,196 patients underwent mitral TEER during the study period. Thirty-day readmissions were stable over time at around 16%. The mean length of stay following TEER decreased from 7 days in 2014 to 5 days in 2018. There was a significant decline in the cost of the index hospitalization of $1311 per year, and a significant decline in the total 30-day cost of $1588 per year (p < 0.001). This was strictly due to a reduction in the cost of the index hospitalization without a change in readmission costs over time (p = 0.23). Infectious causes of readmissions significantly decreased while total cardiovascular readmissions, including heart failure, remained constant.
The decreasing 30-day cost burden of TEER is primarily driven by the shorter index length of stay, as experience in TEER has grown and, length of stay has declined. However, cardiovascular readmissions, and consequently readmission costs, have remained steady.
本研究旨在评估与二尖瓣经导管缘对缘修复术（TEER）相关的费用趋势。
TEER是一种针对手术风险极高且患有中重度二尖瓣反流及纽约心脏协会（NYHA）心功能III或IV级症状患者的治疗选择。TEER术后30天的费用及再入院原因尚未得到充分研究。
在全国再入院数据库中识别出2014年至2018年在美国接受二尖瓣TEER的患者。分析患者特征、特定原因再入院情况以及首次住院和再入院的费用。使用一般线性回归分析费用随时间的趋势。
在研究期间，共有10196例患者接受了二尖瓣TEER。30天再入院率随时间保持稳定，约为16%。TEER术后的平均住院时间从2014年的7天降至2018年的5天。首次住院费用每年显著下降1311美元，30天总费用每年显著下降1588美元（p < 0.001）。这完全是由于首次住院费用的降低，而再入院费用并未随时间变化（p = 0.23）。再入院的感染性原因显著减少，而包括心力衰竭在内的心血管系统再入院总数保持不变。
TEER术后30天费用负担的下降主要是由于首次住院时间缩短，这是随着TEER经验的增加以及住院时间的缩短而导致的。然而，心血管系统再入院率以及相应的再入院费用保持稳定。
