The American journal of cardiology
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Sex-based differences in outcomes have been shown to affect caregiving in medical disciplines. Increased spending due to postacute care transfer policies has led hospitals to further scrutinize patient outcomes and disposition patterns after inpatient admissions. We examined sex-based differences in rehabilitative service utilization after transcatheter aortic valve implantation (TAVI). ⋯ On multivariable logistic regression, female sex was an independent predictor for disposition to rehabilitation facilities after TAVI (odds ratio 2.17; 95% confidence interval: 1.88 to 2.50; p < 0.001). Other independent predictors for females discharged to rehabilitation included the presence of rheumatoid arthritis and collagen vascular disease, body mass index greater than 30 kg/m2, depression, and sum of Elixhauser co-morbidities (all p < 0.001). In conclusion, nonhome discharge TAVI patients added LOS and hospital costs compared to home discharge TAVI patients, and female sex was one of the major predictors despite the lower co-morbidities.
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Comparative Study
Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients ≥80 Years of Age.
Transcatheter aortic valve implantation (TAVI) procedures have increased exponentially since FDA approval in 2011. Older patients who underwent aortic valve replacement, either TAVI or surgical aortic valve replacement (SAVR), have elevated risk. Using the National Readmission Database, we included patients ≥80 years who underwent either TAVI or SAVR from 2011 to 2015. ⋯ Overall, the number of SAVR procedures remained two thirds higher than TAVI. In conclusion, in octo- and nonagenarians, TAVI is an effective and safer alternative to SAVR as it is associated with lower in-hospital mortality, lower major in-hospital complications, lower 30-day readmission rate, and hospital costs. Despite this, SAVR remained the most common approach in octogenarians, although the trends in this data set, suggest a shift in practice patterns for this cohort.