High-functioning TAVR hospitals experience fewer readmissions

Increasing productivity among cardiologists performing transcatheter aortic valve replacements (TAVR) could help lower readmissions, according to a new study that found a correlation between high-volume TAVR hospitals and lower 30-day readmission rates.

The study, published in JAMA Cardiology, was led by Sahil Khera, MD, a cardiologist at Westchester Medical Center in Valhalla, New York.

Other research has shown that the average 30-day readmission rate for patients who underwent TAVR procedures was 17.9 percent. In Khera’s observational study, data was based on a 2014 Nationwide Readmissions Database that identified hospitals with established TAVR programs, which meant performing at least five of the procedures during the first quarter of 2014. The database is part of a collection of databases developed by the Agency for Healthcare Research and Quality for the Healthcare Cost and Utilization Project.

Low-functioning hospitals were classified as those doing less than 50 TAVR procedures, with medium hospitals doing 50 to 100 and high-functioning ones performing more than 100. Of the 129 hospitals in the study, 15.5 percent of them were low volume, 36.4 percent were medium and 48.1 percent were high.

Results showed that 30-day readmissions were significantly lower in the high-volume centers compared with medium and low-volume ones. However, there were no significant differences in length of stay and costs per readmission among the three groups.

“We report for the first time, to our knowledge, an inverse association between hospital TAVR volume and 30-day readmissions,” the authors wrote in the study. “Lower readmission at higher-volume hospitals was associated with significantly lower cost to the health care system.”

For patients who had multiple readmissions within 30 days, the researchers only counted the first one. Additionally, a patient transfer to another hospital was not considered a readmission.

There were about 2,600 readmissions total. Of them, 61.7 percent were because of noncardiac causes, while 39.3 percent were due to cardiac causes.

“We report an inverse association between hospital TAVR volume and 30-day readmissions,” the authors wrote. “The reason for this inverse association is likely multifactorial and depends on patient factors, operator factors, hospital systems, and community factors. Low-volume hospitals had a higher proportion of noncardiac readmissions (infections and respiratory) compared with high-volume hospitals, likely driven by patient factors and procedural approach selection.”