30-day readmission after TAVR (Transcatheter Aortic Valve Replacement (TAVR) in patients with malignancy.

Authors

null

Shristi Upadhyay Upadhyay Banskota

John H. Stroger Hospital of Cook County, Chicago, IL

Shristi Upadhyay Upadhyay Banskota , Miguel Salazar , Estefania Gauto , Hugo Macchi , Prajwal Shrestha , Nabin Khanal

Organizations

John H. Stroger Hospital of Cook County, Chicago, IL, Cleveland Clinic, Cleveland, OH, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, Advocate Masonic Medical Center, Chicago, IL, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, Creighton University School of Medicine, Omaha, NE

Research Funding

No funding received
None

Background: Hospital readmissions after cardiac procedures are increasingly the major focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with readmissions after transcatheter aortic valve replacement (TAVR) in patients with malignancy. Methods: We performed a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for TAVR with a concomitant diagnosis of malignancy. We aimed to identify 30-day readmission rate, mortality, healthcare related utilization of resources and other independent predictors of readmission. Results: A total of 2,213 patients with malignancy underwent TAVR. The 30-days readmission rate was 16% (n=355). Main causes of readmissions were found to be heart failure, sepsis, acute hypercapnic respiratory failure, coronary artery disease with angina, and AKI with ATN. Readmitted patients were more likely to come from small metropolitan areas (43.1% vs 33.6, p≤0.01), micropolitan areas (1.4% vs 0.35%, p≤0.01), rural hospital (20.3% vs 8.8%, p≤0.01), non-teaching hospital (23.5% vs 9.1%, p≤0.01), and small sized hospitals (11.5% vs 4%, p≤0.01). Patients re-admitted were more likely to have malnutrition (8% vs 3.2%, p≤0.01), new VTEs (3.8% vs 0.6, p≤0.01), AKI (26% vs 13.6%, p≤0.01) and deaths (4.6% vs 1.7%, p≤0.01). The total health care in-hospital economic burden of readmission was $5.9 million in total charges and $25 million in total costs. Independent predictors of readmission were disposition to short-term skilled nursing facilities, home-health care, and sepsis. Conclusions: We concluded that readmissions after TAVR in patients with malignancy are associated with higher in-hospital mortality rate and pose a higher health care burden. We also identified risk factors that can be targeted to decrease readmissions after TAVR, health care burden, and patient mortality.

Types of cancer in study population(n=%).
Gastrointestinal
9.6
Breast
0.6
Gynecologic
3.9
Male reproductive
15.4
Urologic
11.1
Hematologic malignancy
52.3
Central nervous system
0.1
Thyroid
0.8
Head and neck
0.9

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Outcomes

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e18620)

DOI

10.1200/JCO.2021.39.15_suppl.e18620

Abstract #

e18620

Abstract Disclosures

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