Association between institutional volume of transcatheter mitral valve repair and readmission rates: A report from the Nationwide Readmission Database
Introduction
Transcatheter edge-to-edge repair (TEER) of the mitral valve has become an established therapy for certain patients with at least moderate-to-severe mitral regurgitation. [[1], [2], [3]] Since its approval, >80,000 patients have undergone TEER at >250 centers in the United States (US). [4] Given that TEER requires relatively complex techniques and close multidisciplinary collaboration teams (i.e. operators, echocardiographers and anesthesiologists), monitoring the risk-adjusted outcomes using national databases are essential to improve the quality of care for patients undergoing TEER. Although previous studies have evaluated the association of institutional experience with clinical outcomes, these have mainly focused on short-term outcomes. [5,6] Little is known about the association between the institutional volume and long-term outcomes using large databases. Our study aimed to describe the institutional volumes of TEER and investigate their association with 180-day readmission rates using a nationally representative contemporary US database. We hypothesized that the institutional learning curve could influence long-term outcomes after TEER, as these patients remain at substantial risk for periprocedural complications and require close monitoring even after discharge.
Section snippets
Data source
For this retrospective cohort study, the Nationwide Readmission Database (NRD), a database of inpatient information designed for readmission analyses developed by the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), was used. The NRD contains approximately 18 million discharge data each year in the US from 28 geographically dispersed states, including patients' age, sex, comorbidities, hospital bed size, length of hospital stay, inpatient procedures
Baseline characteristics and institutional variations of TEER
Table 1 presents the baseline characteristics of the study cohort stratified by tertiles of hospital TEER volume. A total of 4922 patients who underwent TEER (mean age 76.8 ± 10.4 years, and 54.5% male) at 250 institutions were included in the analyses. No significant differences were identified among the three groups. Patients in the highest tertile of the procedure (Q3) were found to have a higher prevalence of hypertension, HF, and anemia. We observed significant variations in the number of
Discussion
TEER of the mitral valve has become an established therapy for certain patients with at least moderate-to-severe MR, however, little is known about the association between the institutional TEER volumes and long-term outcomes using a large-scale database. In this study, we aimed to describe the institutional variations of TEER volume and investigate its association with 180-day readmission rates using a nationally representative contemporary database in the US. The main findings are as follows:
Conclusions
Using a nationally representative contemporary database in the US, we demonstrated that there was a substantial institutional variation in volume of TEER cases and that higher institutional volume was associated with a decreased risk of 180-day readmission rate. Notably, this association was mostly observed in non-elective cases, suggesting the importance of highly skilled heart teams when treating patients who need urgent transcatheter intervention for MR. Further research is required to
Funding
None.
Declaration of Competing Interest
Dr. Inohara is an employee of Eli Lilly Japan K.K., but was not affiliated with Eli Lilly Japan K.K. at the time of the initial submission. Dr. Kohsaka received investigator-initiated grant funding from Pfizer and AstraZeneca; and lecture fees from Pfizer and Bristol-Myers Squibb. Dr. Latib is a consultant for Edwards Lifesciences, Medtronic, Abbott, Boston Scientific.
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Cited by (1)
Current Percutaneous Approaches to Treat Mitral Valve Regurgitation
2023, Current Treatment Options in Cardiovascular Medicine
- 1
Contributed equally as first authors.