Early versus late discharge after transcatheter aortic valve replacement and readmissions for permanent pacemaker implantation. Issue 2 (27th June 2022)

• Record Type: Journal Article
• Authors: Elzanaty, Ahmed M.; Maraey, Ahmed; Elbadawi, Ayman; Khalil, Mahmoud; Hashim, Ahmed; Vyas, Rohit; Moustafa, Abdelmoneim; Ramanthan, Periakaruppan Kasi; Mentias, Amgad; Abbott, J. Dawn; Aronow, Herbert D.; Kapadia, Samir; Saad, Marwan
• Is Part Of: Catheterization and cardiovascular interventions. Volume 100:Issue 2(2022)
• Page Start: 245
• Page End: 253
• Publication Date: 2022-06-27
• Subjects: conduction abnormalities -- discharge timing -- permanent pacemaker implantation -- TAVR -- transcatheter aortic valve replacement; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30299
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objective: To examine the rate of readmission for permanent pacemaker (PPM) implantation with early versus late discharge after transcatheter aortic valve replacement (TAVR). Background: There is a current trend toward early discharge after TAVR. However, paucity of data exists on the impact of such practice on readmissions for PPM implantation. Methods: The Nationwide Readmission Database 2016–2018 was queried for all hospitalizations where patients underwent TAVR. Hospitalizations were stratified into early (Days 0 and 1) versus late (≥Day 2) discharge groups. Observations in which PPM was required in the index admission were excluded. Multivariable regression analyses involving patient‐ and hospital‐related variables were utilized. The primary outcome was 90‐day readmission for PPM implantation. Results: The final analysis included 68, 482 TAVR hospitalizations, 20, 261 (29.6%) with early versus 48, 221 (70.4%) with late discharge. Early discharge after TAVR increased over the study period (16.2% in 2016 vs. 37.9% in 2018, P trend < 0.01). Nevertheless, 90‐day readmission for PPM implantation remained stable (1.8% in 2016 vs. 2.0% in 2018, P trend = 0.32). The 90‐day readmission rate for PPM implantation (2.0% vs. 1.8%; adjusted odds ratio: 1.15; 95% confidence interval: 0.95–1.39; p = 0.15) and median time‐to‐readmission (5 days [interquartile range, IQR 3–9] vs. 5 days [IQR 3–14], p = 0.92) were similar with early versus late discharge. Similar rates were observed regardless of whether readmission was elective versus not. Early discharge was associated with lower hospitalization cost ($39, 990 ± $13, 681 vs. $46, 750 ± $18, 218, p < 0.01) compared with late discharge. Conclusion: In patients who did not require PPM during the index TAVR hospitalization, the rate of readmission for PPM implantation was similar with early versus late discharge. Perspective: What is known: Permanent pacemaker implantation is a known complication after TAVR and can impact early postoperative discharge. What is new: Rate of readmission for permanent pacemaker implantation is similar with early versus late discharge after TAVR. What is next: Randomized trials are needed to establish safe protocols for early discharge after TAVR.