Same-day discharge after TAVR is safe for low-risk patients, leads to considerable cost savings
Same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) is not associated with a greater risk of 30-day readmission, according to new findings published in the American Journal of Cardiology.[1]
“Studies have demonstrated that early and even next-day discharge for some patients who underwent modern minimalist TAVR is safe and feasible without an increase in the risk of complications,” wrote first author Akshay Goel, MD, of Westchester Medical Center in Valhalla, New York, and colleagues. “Whether further expediting discharge after TAVR by allowing SDD in selected patients is safe or derives additional benefits remains unanswered.”
Goel et al. examined data from the National Readmission Database, focusing on more than 196,000 TAVR patients treated from 2015 to 2019. The mean patient age was 79.5 years old, and 55% of patients were men.
“This is by far the largest analysis of TAVR patients to date that we are aware of,” the group wrote.
While 245 patients (0.12%) were discharged on the same day, the remaining patients were all discharged on a different day. The median length of stay for different-day discharge (DDD) patients was two days. The median hospitalization costs were “significantly lower” for SDD patients ($37,800) than DDD patients ($49,100).
SDD patients tended to be slightly younger than DDD patients, the authors added, and were less likely to present with a history of stroke. Also, 36.8% of SDD patients were women, but 45% of DDD patients were women.
Propensity score matching was performed to compare outcomes between the two groups. The 30-day readmission rate was 11% for the same day discharge TAVR patients, and 10.6% for DDD patients.
The researchers also focused on some of the potential advantages and risks associated with post-TAVR SDD.
“SDD offers several potential advantages in addition to shorter hospitalization length and lower health care costs, including better resource use, greater patient satisfaction, and minimization of potential in-hospital exposure to COVID-19,” they wrote. “In contrast, potential risks of SDD after TAVR include missed or delayed care of nonimmediate complications such as delayed bleeding, vascular complications, conduction abnormalities requiring a pacemaker, stroke, and so on. This risk can be significantly minimized by selecting the right patients for SDD. This study suggests that SDD after minimalist-approach TAVR may be safe and feasible in selected patients free of immediate periprocedural complications and at low risk of clinical events after discharge.”
Researchers from the Cleveland Clinic’s Heart, Vascular and Thoracic Institute reached a similar conclusion in March 2022.
Related TAVR Content:
Left bundle branch block after TAVR hurts outcomes, even when no permanent pacemaker is required
New data on cardiac damage before and after AVR suggests earlier treatment may be beneficial
CT-FFR before TAVR improves detection of coronary artery disease, limits invasive imaging exams
Reference:
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.