Hasan Irsa, Brown James A, Aranda-Michel Edgar, Serna-Gallegos Derek, Gada Hemal, Kliner Dustin, Toma Catalin, Sanon Saurabh, Wang Yisi, Sultan Ibrahim
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2022 Nov;37(11):3550-3555. doi: 10.1111/jocs.16833. Epub 2022 Sep 8.
Prior studies have demonstrated that outcomes of invasive cardiac interventions may vary by hospital teaching status and volume. As transcatheter aortic valve replacement (TAVR) rapidly expands from teaching to nonteaching hospitals across the country, the clinical impact of hospital teaching status has not been clearly established. This study aimed to compare TAVR outcomes between nonteaching and teaching hospitals.
An observational study was conducted using the Nationwide Readmission Database (NRD). Patients undergoing TAVR from 2011 to 2018 were included. Data was analyzed using multivariable logistic regression to determine outcomes of 30-day mortality and readmission between nonteaching and teaching hospitals.
A total of 235,321 patients underwent TAVR during the study period. Patients undergoing TAVR at teaching hospitals presented with a higher frequency of baseline comorbidities compared to nonteaching hospitals. Postprocedure complications such as myocardial infarction, arrhythmia, pneumonia, acute kidney injury, sepsis, stroke, and hemorrhage occurred more often at teaching centers (p < 0.001); translating to a higher rate of in-hospital mortality (2.27% vs. 1.99%, p = 0.006) and hospital cost ($48,300 vs. $44,900, p < 0.001) in teaching versus nonteaching hospitals. After adjusting for baseline characteristics and postoperative morbidity, in-hospital mortality (p = 0.095) and readmission rate (p = 0.420) on multivariable analysis were not statistically different between centers.
With the evolution and expansion of TAVR to nonteaching centers, mortality, and readmission rates are not significantly different between nonteaching and teaching hospitals. Higher unadjusted in-hospital mortality at teaching centers suggest these centers more often treat high risk patients with associated increased complications.
先前的研究表明，侵入性心脏干预的结果可能因医院的教学地位和手术量而异。随着经导管主动脉瓣置换术（TAVR）在全国范围内从教学医院迅速扩展到非教学医院，医院教学地位的临床影响尚未明确确立。本研究旨在比较非教学医院和教学医院的TAVR结果。
使用全国再入院数据库（NRD）进行了一项观察性研究。纳入了2011年至2018年接受TAVR的患者。使用多变量逻辑回归分析数据，以确定非教学医院和教学医院之间30天死亡率和再入院的结果。
在研究期间，共有235,321名患者接受了TAVR。与非教学医院相比，在教学医院接受TAVR的患者基线合并症发生率更高。教学中心术后并发症如心肌梗死、心律失常、肺炎、急性肾损伤、败血症、中风和出血更为常见（p < 0.001）；这导致教学医院的住院死亡率（2.27%对1.99%，p = 0.006）和住院费用（48,300美元对44,900美元，p < 0.001）高于非教学医院。在调整基线特征和术后发病率后，多变量分析显示各中心之间的住院死亡率（p = 0.095）和再入院率（p = 0.420）无统计学差异。
随着TAVR向非教学中心的发展和扩展，非教学医院和教学医院之间的死亡率和再入院率无显著差异。教学中心未经调整的较高住院死亡率表明，这些中心更常治疗高危患者，并发症相应增加。
