Department of Medicine, Cook County Health, Chicago, Illinois, United States of America.
Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea.
PLoS One. 2022 Oct 20;17(10):e0276394. doi: 10.1371/journal.pone.0276394. eCollection 2022.
We sought to examine readmission rates and predictors of hospital readmission following TAVR in patients with ESRD.
End-stage renal disease (ESRD) is associated with poor outcomes following transcatheter aortic valve replacement (TAVR).
We assessed index hospitalizations for TAVR from the National Readmissions Database from 2017 to 2018 and used propensity scores to match those with and without ESRD. We compared 90-day readmission for any cause or cardiovascular cause. Length of stay (LOS), mortality, and cost were assessed for index hospitalizations and 90-day readmissions. Multivariable logistic regression was performed to identify predictors of 90-day readmission.
We identified 49,172 index hospitalizations for TAVR, including 1,219 patients with ESRD (2.5%). Patient with ESRD had higher rates of all-cause readmission (34.4% vs. 19.2%, HR 1.96, 95% CI 1.68-2.30, p<0.001) and cardiovascular readmission (13.2% vs. 7.7%, HR 1.85, 95% CI 1.44-2.38, p<0.001) at 90 days. During index hospitalization, patients with ESRD had longer length of stay (mean difference 1.9 days), increased hospital cost (mean difference $42,915), and increased in-hospital mortality (2.6% vs. 0.9%). Among those readmitted within 90 days, patients with ESRD had longer LOS and increased hospital charge, but similar in-hospital mortality. Diabetes (OR 1.86, 95% CI 1.31-2.64) and chronic pulmonary disease (OR 1.51, 95% CI 1.04-2.18) were independently associated with higher odds of 90-day readmission in patients with ESRD.
Patients with ESRD undergoing TAVR have higher mortality and increased cost associated with their index hospitalization and are at increased risk of readmission within 90 days following TAVR.
我们旨在研究终末期肾病（ESRD）患者行经导管主动脉瓣置换术（TAVR）后的再入院率和再入院预测因素。
ESRD 与 TAVR 后的不良预后相关。
我们从 2017 年至 2018 年的国家再入院数据库中评估了 TAVR 的索引住院治疗，并使用倾向评分匹配有和无 ESRD 的患者。我们比较了任何原因或心血管原因的 90 天再入院率。评估了索引住院和 90 天再入院的住院时间（LOS）、死亡率和费用。多变量逻辑回归用于确定 90 天再入院的预测因素。
我们确定了 49172 例 TAVR 的索引住院治疗，其中 1219 例患者患有 ESRD（2.5%）。患有 ESRD 的患者全因再入院率（34.4%比 19.2%，HR 1.96，95%CI 1.68-2.30，p<0.001）和心血管再入院率（13.2%比 7.7%，HR 1.85，95%CI 1.44-2.38，p<0.001）均较高。在索引住院期间，患有 ESRD 的患者住院时间较长（平均差异 1.9 天），住院费用较高（平均差异$42915），院内死亡率增加（2.6%比 0.9%）。在 90 天内再入院的患者中，患有 ESRD 的患者住院时间较长，住院费用增加，但院内死亡率相似。糖尿病（OR 1.86，95%CI 1.31-2.64）和慢性肺部疾病（OR 1.51，95%CI 1.04-2.18）与 ESRD 患者 90 天再入院的可能性较高独立相关。
接受 TAVR 的 ESRD 患者的死亡率更高，与索引住院相关的费用也更高，并且在 TAVR 后 90 天内再入院的风险增加。
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