A. Iyengar1, E. Aguayo1, Y. Seo1, Y. Sanaiha3, O. Kwon2, R. Satou2, P. Benharash2 1University Of California – Los Angeles,David Geffen School Of Medicine,Los Angeles, CA, USA 2University Of California – Los Angeles,Cardiac Surgery,Los Angeles, CA, USA 3University Of California – Los Angeles,General Surgery,Los Angeles, CA, USA
Introduction:
Vascular injuries are the most common complication following transcatheter aortic valve replacement (TAVR), and significantly contribute to morbidity and mortality in the perioperative period. While reducing the risk of vascular rupture, percutaneous access and smaller delivery devices may adversely impact the incidence of pseudoaneurysms. Although typically benign, the effect of access site pseudoaneurysms on resource utilization remain poorly defined. The purpose of this study was to characterize the impact of access site pseudoaneurysms on hospital costs and readmission rates.
Methods:
Retrospective analysis of the National Readmissions Database was performed between January 2012 & December 2014 using the International Classification of Diseases, Ninth Revision procedural codes for TAVR (35.05 and 35.06) and pseudoaneurysm formation (442.3). Costs were standardized to the 2014 US gross domestic product using US Department of Commerce consumer price indices and adjusted for diagnosis related group–based severity. The Kruskal-Wallis and chi-squared tests were used for comparisons between all cohorts.
Results:
Of the 32,976 patients who underwent TAVR, 542 (1.6%) were identified as having the complication of pseudoaneurysm. Development of a pseudoaneurysm was associated with older age (84 vs. 82 years, p=0.009), higher prevalence of peripheral vascular disease (39% vs. 26%, p<0.001), and a higher Elixhauser Comorbidity Index (7 vs 6, p=0.033). While 295 (0.9%) patients were diagnosed with pseudoaneurysms at the index hospitalization, 246 (0.6%) were discovered during a readmission.
At index hospitalization, pseudoaneurysm formation was associated with significantly increased length of stay (8 vs. 5 days, p<0.001) and increased total costs ($68,379 vs. $58,871, p<0.001). Endovascular intervention was utilized in 13% of pseudoaneurysms, while open surgical intervention was required in 2% of cases. Readmissions for pseudoaneurysms were also associated with significantly increased length of stay (5 vs. 4 days, p=0.012) and hospital costs ($20,464 vs. $14,835). Among readmissions, endovascular intervention was utilized in 4.4% of pseudoaneurysms, while open surgical intervention was required in 0.7% of cases.
Conclusion:
Pseudoaneurysm formation is more prevalent in older patients with pre-existing peripheral vascular disease. During both index hospitalization and readmissions, lengths of stay and hospital costs are significantly increased by presence of pseudoaneurysms despite low rates of endovascular or open surgical intervention. Strategies to reduce the formation of pseudoaneurysms after TAVR may serve as a suitable target for improvement in the delivery of quality care.
