Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA.
Department of Internal Medicine, University of North Dakota, Bismarck, North Dakota, USA.
Catheter Cardiovasc Interv. 2022 Aug;100(2):245-253. doi: 10.1002/ccd.30299. Epub 2022 Jun 27.
To examine the rate of readmission for permanent pacemaker (PPM) implantation with early versus late discharge after transcatheter aortic valve replacement (TAVR).
There is a current trend toward early discharge after TAVR. However, paucity of data exists on the impact of such practice on readmissions for PPM implantation.
The Nationwide Readmission Database 2016-2018 was queried for all hospitalizations where patients underwent TAVR. Hospitalizations were stratified into early (Days 0 and 1) versus late (≥Day 2) discharge groups. Observations in which PPM was required in the index admission were excluded. Multivariable regression analyses involving patient- and hospital-related variables were utilized. The primary outcome was 90-day readmission for PPM implantation.
The final analysis included 68,482 TAVR hospitalizations, 20,261 (29.6%) with early versus 48,221 (70.4%) with late discharge. Early discharge after TAVR increased over the study period (16.2% in 2016 vs. 37.9% in 2018, P < 0.01). Nevertheless, 90-day readmission for PPM implantation remained stable (1.8% in 2016 vs. 2.0% in 2018, P = 0.32). The 90-day readmission rate for PPM implantation (2.0% vs. 1.8%; adjusted odds ratio: 1.15; 95% confidence interval: 0.95-1.39; p = 0.15) and median time-to-readmission (5 days [interquartile range, IQR 3-9] vs. 5 days [IQR 3-14], p = 0.92) were similar with early versus late discharge. Similar rates were observed regardless of whether readmission was elective versus not. Early discharge was associated with lower hospitalization cost ($39,990 ± $13,681 vs. $46,750 ± $18,218, p < 0.01) compared with late discharge.
In patients who did not require PPM during the index TAVR hospitalization, the rate of readmission for PPM implantation was similar with early versus late discharge.
研究经导管主动脉瓣置换术（TAVR）后早期与晚期出院的永久性心脏起搏器（PPM）植入患者的再入院率。
目前 TAVR 后有提前出院的趋势。然而，关于这种做法对 PPM 植入再入院的影响的数据很少。
2016-2018 年，在全国再入院数据库中查询所有接受 TAVR 治疗的患者的住院情况。将住院情况分为早期（第 0 和 1 天）和晚期（≥第 2 天）出院组。排除索引入院时需要 PPM 的观察结果。使用涉及患者和医院相关变量的多变量回归分析。主要结局为 90 天内因 PPM 植入而再次入院。
最终分析纳入了 68482 例 TAVR 住院患者，其中 20261 例（29.6%）为早期出院，48221 例（70.4%）为晚期出院。TAVR 后早期出院的比例在研究期间有所增加（2016 年为 16.2%，2018 年为 37.9%，P < 0.01）。然而，90 天内因 PPM 植入而再次入院的比例保持稳定（2016 年为 1.8%，2018 年为 2.0%，P = 0.32）。PPM 植入的 90 天再入院率（2.0%比 1.8%；调整后的优势比：1.15；95%置信区间：0.95-1.39；p = 0.15）和中位再入院时间（5 天[四分位距，IQR 3-9]比 5 天[IQR 3-14]，p = 0.92）在早期和晚期出院时相似。无论再入院是否为择期，结果均相似。与晚期出院相比，早期出院与较低的住院费用相关（39990 ± 13681 美元比 46750 ± 18218 美元，p < 0.01）。
在索引 TAVR 住院期间不需要 PPM 的患者中，早期与晚期出院的 PPM 植入再入院率相似。
