Hospital Variation in 30‐Day Readmissions Following Transcatheter Aortic Valve Replacement

Abstract

Background Data on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown. Methods and Results We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TAVRs. Hierarchical logistic regression models were used to examine between‐hospital variation in 30‐day all‐cause risk‐standardized readmission rate (RSRR) after TAVR and to explore reasons underlying hospital variation in 30‐day RSRR. The study included 27 091 index TAVRs performed across 325 hospitals. The median (interquartile range) hospital‐level 30‐day RSRR was 11.9% (11.1%–12.8%) ranging from 8.8% to 16.5%. After adjusting for differences in patient characteristics, there was significant between‐hospital variation in 30‐day RSRR (hospital odds ratio, 1.59; 95% CI, 1.39–1.77). Differences in length of stay and discharge disposition accounted for 15% of the between‐hospital variance in RSRRs. There was no significant association between hospital characteristics and 30‐day readmission rates after TAVR. There was statistically significant but weak correlation between 30‐day RSRR after TAVR and that after surgical aortic valve replacement, percutaneous coronary intervention, acute myocardial infarction, heart failure, and pneumonia (r=0.132–0.298; P<0.001 for all). Causes of 30‐day readmission varied across hospitals, with noncardiac readmissions being more common at the bottom 5% hospitals (ie, those with the highest RSRRs). Conclusions There is significant variation in 30‐day RSRR after TAVR across hospitals that is not entirely explained by differences in patient or hospital characteristics as well as hospital‐wide practice patterns. Noncardiac readmissions are more common in hospitals with the highest RSRRs.

Keywords

• aortic stenosis
• hospital variation
• readmission
• transcatheter aortic valve replacement