Next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) as opposed to a two- or three-day hospitalization can lower costs without increasing the risk of complications, according to new findings published in Current Problems in Cardiology.
“There has been an increased focus on reducing readmission rates after TAVR as this could improve overall outcomes and reduce the burden of increased cost on the health care system,” wrote first author Rahul Gupta, MD, a specialist at Lehigh Valley Heart Institute in Allentown, Pennsylvania, and colleagues. “Longer length of in-hospital stays leading to increased health-care-associated infections are responsible for 13% of readmissions and result in 18 to 30% of mortality in TAVR patients.”
The authors performed a systematic review and meta-analysis, exploring data from six different studies and more than 2,600 patients. The included studies all compared outcomes after NDD with outcomes after early discharge (ED), defined as “within the next three days.”
Overall, Gupta et al. found that NDD after TAVR was associated with fewer bleeding and vascular complications than ED.
Patients in the NDD group were also less likely to require permanent pacemaker (PPM) implantation.
“Conduction abnormalities usually occur either during or immediately after the TAVR procedure,” the authors wrote. “Most studies reported a median time of three days from TAVR to PPM implantation, and almost 90% of PPMs were implanted within seven days of TAVR. This late-appearing conduction defect raises the question of safety of NDD. However … [the] NDD group was associated with a lower rate of post-TAVR PPM insertion compared to the ED group.”
The risk of 30-day mortality, stroke, acute kidney injury or readmission were all similar between the two treatment options.
“With the financial benefit and comparable complication rate to ED, NDD for TAVR is a reasonable option for patients with severe aortic stenosis,” the group concluded. “However, this needs to be further evaluated in prospective studies to carefully account for observational bias that may be a factor in this finding.”
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.