Early versus late discharge after transcatheter aortic valve replacement and readmissions for permanent pacemaker implantation

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 p...

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Published in:	Catheterization and cardiovascular interventions Vol. 100; no. 2; pp. 245 - 253
Main 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
Format:	Journal Article
Language:	English
Published:	Washington Wiley Subscription Services, Inc 01-08-2022
Subjects:	Aortic valve Clinical trials conduction abnormalities discharge timing Hospitalization Pacemakers Patients permanent pacemaker implantation TAVR transcatheter aortic valve replacement
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Summary:	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, Ptrend < 0.01). Nevertheless, 90‐day readmission for PPM implantation remained stable (1.8% in 2016 vs. 2.0% in 2018, Ptrend = 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.
Bibliography:	Ahmed M. Elzanaty and Ahmed Maraey contributed equally to this study. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1522-1946 1522-726X
DOI:	10.1002/ccd.30299