Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge

Background: There is a concerted push for adopting a minimalist strategy with emphasis on early hospital discharge for patients undergoing Transcatheter aortic valve implantation (TAVI). However, studies on discharge patterns and predictors of early discharge (≤3 days post-TAVI) are sparse, in the United States.

Methods: We analyzed using Healthcare Utilization Project, Nationwide Inpatient Sample database, 2011-2012. A total of 7321 TAVI procedures were identified. We compared in-hospital outcomes between early and late discharge cohorts, and determined the predictors of early discharge. Correlation of costs and post-TAVI length of stay was also performed.

Results: Early discharge rate post-TAVI was about 21% in the United States, in 2011-2012. Overall mean age was 81 years. In-hospital adverse outcomes post-TAVI were higher in late discharge cohort (P < 0.001). Mean length of stay post-TAVI (7.7 days vs 2.6 days) and costs ($208 752 vs $157 663) were significantly higher in late discharge than early discharge cohort. Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support, acute kidney injury were associated with significantly lower adjusted odds for early discharge. Transfemoral TAVI approach, prior aortic valvuloplasty, and procedure year 2012 were associated with significantly higher odds for early discharge. We observed positive correlation between costs of hospitalization and post-TAVI length of stay (R = 0.58; P < 0.001).

Conclusions: Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support devices, renal failure were associated with lower odds for early discharge. Transfemoral approach and prior aortic valvuloplasty increased the likelihood for early discharge. Post-TAVI length of stay was associated with significantly higher hospitalization costs.