Hospital Variation in 30-Day Readmissions Following Transcatheter Aortic Valve Replacement.
Hospital Variation in 30-Day Readmissions Following Transcatheter Aortic Valve Replacement.
复制标题
经导管主动脉瓣置换术后 30 天再入院率的医院变化。
DOI：
10.1161/jaha.120.021350
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发表时间：
2021-05-18
影响因子：
5.4
通讯作者：
Elmariah S
中科院分区：
文献类型：
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作者：
Kolte D;Kennedy K;Wasfy JH;Jena AB;Elmariah S
经导管主动脉瓣置换术（TAVR）后30天再入院率的医院差异数据有限。此外，这种变化是否可以用医院特征和医院实践模式的差异来解释仍然是未知的。我们使用2017年全国再入院数据库来确定至少进行了5次TAVR的医院。使用分层逻辑回归模型检查TAVR术后30天全因风险标准化再入院率（RSRR）的医院间差异，并探索30天RSRR的医院差异的原因。该研究包括在325家医院进行的27091例首次TAVR。中位（四分位距）医院级30天RSRR为11.9%（11.1%-12.8%），范围为8.8%-16.5%。调整患者特征差异后，30天RSRR在医院间存在显著差异（医院比值比，1.59; 95% CI，1.39-1.77）。住院时间和出院处置的差异占RSRR医院间差异的15%。医院特征与TAVR术后30天再入院率之间无显著相关性。TAVR后30天RSRR与外科主动脉瓣置换术、经皮冠状动脉介入治疗、急性心肌梗死、心力衰竭和肺炎后的RSRR之间存在统计学显著但较弱的相关性（r=0.132-0.298;均P<0.001）。30天再入院的原因因医院而异，非心脏再入院在底部5%的医院（即RSRR最高的医院）更常见。TAVR后30天RSRR在各医院之间存在显著差异，这不能完全由患者或医院特征以及医院范围内的实践模式的差异来解释。非心脏再入院在RSRR最高的医院更常见。
Data on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown. We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TAVRs. Hierarchical logistic regression models were used to examine between‐hospital variation in 30‐day all‐cause risk‐standardized readmission rate (RSRR) after TAVR and to explore reasons underlying hospital variation in 30‐day RSRR. The study included 27 091 index TAVRs performed across 325 hospitals. The median (interquartile range) hospital‐level 30‐day RSRR was 11.9% (11.1%–12.8%) ranging from 8.8% to 16.5%. After adjusting for differences in patient characteristics, there was significant between‐hospital variation in 30‐day RSRR (hospital odds ratio, 1.59; 95% CI, 1.39–1.77). Differences in length of stay and discharge disposition accounted for 15% of the between‐hospital variance in RSRRs. There was no significant association between hospital characteristics and 30‐day readmission rates after TAVR. There was statistically significant but weak correlation between 30‐day RSRR after TAVR and that after surgical aortic valve replacement, percutaneous coronary intervention, acute myocardial infarction, heart failure, and pneumonia (r=0.132–0.298; P<0.001 for all). Causes of 30‐day readmission varied across hospitals, with noncardiac readmissions being more common at the bottom 5% hospitals (ie, those with the highest RSRRs). There is significant variation in 30‐day RSRR after TAVR across hospitals that is not entirely explained by differences in patient or hospital characteristics as well as hospital‐wide practice patterns. Noncardiac readmissions are more common in hospitals with the highest RSRRs.