Diaz-Castrillon Carlos E, Kliner Dustin, Serna-Gallegos Derek, Toma Catalin, Smith Aj Conrad, Gada Hemal, Makani Amber, Hasan Irsa, Ogami Takuya, Wang Yisi, Sultan Ibrahim
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
CJC Open. 2025 Jan 27;7(4):481-488. doi: 10.1016/j.cjco.2024.12.014. eCollection 2025 Apr.
Variability in transcatheter aortic valve replacement (TAVR) readmission rates highlights the importance of assessing post-discharge outcomes. Understanding how teaching hospital status and causes of readmission influence mortality could optimise post-TAVR care.
Using the National Readmissions Database, we identified 155,298 TAVR admissions from 2012 to 2020. We evaluated the interaction effect between teaching status and cause of readmission on readmission-related mortality through adjusted mixed-effects models.
Overall, 18.9% of patients (n = 29,479) had a nonelective readmission within 90 days, with no significant difference between teaching and nonteaching hospitals (19.3% vs 18.9%; > 0.05). Cardiac-related readmissions accounted for 42.7% of cases, while noncardiac readmissions made up 57.3%, with no differences observed in their distribution between teaching and nonteaching hospitals. The unadjusted 90-day readmission mortality rate was 3.8%, without significant differences between teaching and nonteaching hospitals (3.8% vs 4.1%; = 0.38). A downward trend in nonelective readmission and readmission-related mortality rates was observed, regardless of teaching status. An interaction effect between teaching status and the cause of readmission was identified: Noncardiac readmissions to teaching hospitals were associated with increased odds of death (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.59-2.07; < 0.001) compared with nonteaching hospitals, whereas cardiac readmissions to teaching hospitals were associated with decreased odds of in-hospital mortality (OR 0.55, 95% CI 0.48-0.62; < 0.001).
Our findings indicate a differential association between teaching hospital status and 90-day readmission mortality, contingent on the cause of readmission. Further research, including the use of metrics such as failure to rescue, is needed to better understand the relationship between patient-level variables and teaching hospital status.
经导管主动脉瓣置换术（TAVR）再入院率的差异凸显了评估出院后结局的重要性。了解教学医院状况和再入院原因如何影响死亡率有助于优化TAVR术后护理。
利用国家再入院数据库，我们确定了2012年至2020年期间155,298例TAVR入院病例。我们通过调整后的混合效应模型评估了教学状况和再入院原因对再入院相关死亡率的交互作用。
总体而言，18.9%的患者（n = 29,479）在90天内进行了非选择性再入院，教学医院和非教学医院之间无显著差异（19.3%对18.9%；P>0.05）。心脏相关再入院占病例的42.7%，而非心脏再入院占57.3%，教学医院和非教学医院之间在其分布上未观察到差异。未经调整的90天再入院死亡率为3.8%，教学医院和非教学医院之间无显著差异（3.8%对4.1%；P = 0.38）。无论教学状况如何，均观察到非选择性再入院率和再入院相关死亡率呈下降趋势。确定了教学状况和再入院原因之间的交互作用：与非教学医院相比，教学医院的非心脏再入院与死亡几率增加相关（优势比[OR]1.82，95%置信区间[CI]1.59 - 2.07；P<0.001），而教学医院的心脏再入院与住院死亡率降低相关（OR 0.55，95%CI 0.48 - 0.62；P<0.001）。
我们的研究结果表明，教学医院状况与90天再入院死亡率之间存在差异关联，这取决于再入院原因。需要进一步研究，包括使用诸如未能挽救等指标，以更好地理解患者层面变量与教学医院状况之间的关系。
