M. Lopez1, J. Parreco1, M. Eby1, J. Buicko1, R. Kozol1 1University Of Miami, Palm Beach,General Surgery Residency,Miami, FL, USA
Introduction:
The Healthcare Cost and Utilization Project (HCUP) released the first version of the Nationwide Readmission Database (NRD) in 2015. The NRD is unique in that it allows for tracking a patient across hospitals and supports analysis of national readmission rates. This database was used to compare various clinical outcomes and costs associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).
Methods:
The NRD was queried for all patients undergoing SAVR or TAVI in 2013 that were over the age of 18. Propensity matching was performed, 1 to 1, using age, gender, elective status and 12 comorbidities. Multivariate logistic regression was then implemented on matched versus unmatched datasets on all outcomes of interest. Kaplan-Meier curves were then constructed for the mortality endpoint.
Results:
There were 39,270 patients who underwent aortic valve procedures (33,191 with SAVR compared to 6,079 with TAVI). Baseline analysis revealed the TAVI patients were older and had more comorbidities. Propensity matching resulted in 8,774 patients (4,387 patients per group). The mean sum of length of stay (LOS) including readmissions was less in TAVI patients (unmatched 12.5 vs 13.4 days, p < 0.01 and matched 12.0 vs 14.2 days, p < 0.01) and the mean total cost of readmissions was similar in both groups (unmatched $23,114 vs $22,629, p = 0.57 and matched $22,805 vs $22,220, p = 0.62).
Conclusion:
Initial admission costs are greater for patients undergoing TAVI compared to patients undergoing SAVR. However, after factoring in readmissions, the mean LOS for patients undergoing TAVI is less than the LOS for those undergoing SAVR, and the mean cost of readmissions is similar in both groups. Additionally, any excess mortality risk associated with TAVI was eliminated via a matching procedure.