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Original research
Hospital variation of 30-day readmission rate following transcatheter aortic valve implantation
  1. Tomo Ando1,
  2. Said Ashraf2,
  3. Toshiki Kuno3,
  4. Alexandros Briasoulis4,
  5. Hisato Takagi5,
  6. Cindy Grines6,
  7. Aaqib Malik7
  1. 1Division of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
  2. 2Division of Interventional Cardiology, New York University Langone Medical Center, New York City, New York, USA
  3. 3Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York City, New York, USA
  4. 4Division of Cardiology, University of Iowa, Iowa City, Iowa, USA
  5. 5Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
  6. 6Division of Interventional Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
  7. 7Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
  1. Correspondence to Dr Tomo Ando, Cardiology, Kawasaki Saiwai Hospital, Kawasaki 212-0014, Japan; andotomo{at}hotmail.co.jp

Abstract

Objectives Thirty-day readmission rate is one of the hospital quality metrics. Outcomes of transcatheter aortic valve implantation (TAVI) have improved significantly, but it remains unclear whether hospital-level variance in 30-day readmission rate exists in the contemporary TAVI era.

Methods From the 2017 US Nationwide Readmission Database, endovascular TAVI were identified. The unadjusted 30-day readmission rate and 30-day risk-standardised readmission rate (RSRR) were calculated and we then conducted model testing to determine the relative contribution of hospital characteristics, patient-level covariates and economic status to the variation in readmission rates observed between the hospitals.

Results A total of 44 899 TAVI from 338 hospitals were identified. The range of unadjusted 30-day readmission rate and 30-day RSRR was 2.0%–33.3% and 9.4%–15.3%, respectively. Median 30-day RSRR was 11.8% and there was a significant hospital-level variation (median OR 1.22, 95% CI 1.16 to 1.32, p<0.01) and this was similar in both readmissions caused due to major cardiac and non-cardiac conditions. Patient, hospital and economic factors accounted for 9.6%, 1.9% and 3.8% of the variability in hospital readmission rate, respectively.

Conclusions There was significant hospital-level variation in 30-day RSRR following TAVI. Further measures are required to mitigate this variance in the readmission rate.

  • transcatheter aortic valve replacement
  • quality of health care
  • aortic valve stenosis

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Footnotes

  • Contributors Writing manuscript, design of the study and responsible for the overall content of the manuscript: TA. Writing manuscript and design of the study: SA. Design of the study and responsible for the overall content of the manuscript: TK. Writing manuscript, design of the study and responsible for the overall content of the manuscript: HB. Design of the study and writing manuscript: HT. Responsible for the overall content of the manuscript: CG. Writing manuscript, design of the study, performed statistical analysis and responsible for the overall content of the manuscript: AM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was considered exempted from approval from the Institutional Board of Review as the NRD is publicly available data and cases are appropriately de-identified.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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