Incidence and Predictors of Readmissions to Non-Index Hospitals After Transcatheter Aortic Valve Implantation in the Contemporary Era in New South Wales, Australia

Md Shajedur Rahman Shawon; Jonathon B Ryan; Louisa Jorm

doi:10.1016/j.hlc.2024.02.012

Incidence and Predictors of Readmissions to Non-Index Hospitals After Transcatheter Aortic Valve Implantation in the Contemporary Era in New South Wales, Australia

Heart Lung Circ. 2024 Apr 4:S1443-9506(24)00130-6. doi: 10.1016/j.hlc.2024.02.012. Online ahead of print.

Authors

Md Shajedur Rahman Shawon¹, Jonathon B Ryan², Louisa Jorm³

Affiliations

¹ Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia. Electronic address: s.shawon@unsw.edu.au.
² Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
³ Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.

PMID: 38580581
DOI: 10.1016/j.hlc.2024.02.012

Abstract

Background: In Australia, transcatheter aortic valve implantation (TAVI) is only performed in a limited number of specialised metropolitan centres, many of which are private hospitals, making it likely that TAVI patients who require readmission will present to another (non-index) hospital. It is important to understand the impact of non-index readmission on patient outcomes and healthcare resource utilisation.

Method: We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years, who had an emergency readmission within 90 days following a TAVI procedure in 2013-2022. Mixed-effect, multi-level logistic regression models were used to evaluate predictors of non-index readmission, and associations between non-index readmission and readmission length of stay, 90-day mortality, and 1-year mortality.

Results: Of 4,198 patients (mean age, 82.7 years; 40.6% female) discharged alive following TAVI, 933 (22.2%) were readmitted within 90 days of discharge. Over three-quarters (76.0%) of those readmitted returned to a non-index hospital, with no significant difference in readmission principal diagnosis between index hospital and non-index hospital readmissions. Among readmitted patients, independent predictors of non-index readmission included: residence in regional or remote areas, lower socio-economic status, having a pre-procedure transfer, and a private index hospital. Readmission length of stay (median, 4 days), 90-day mortality (adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.56-1.96) and 1-year mortality (adjusted OR 1.01, 95% CI 0.64-1.58) were similar between index and non-index readmissions.

Conclusions: Non-index readmission following TAVI was highly prevalent but not associated with increased mortality or healthcare utilisation. Our results are reassuring for TAVI patients in regional and remote areas with limited access to return to index TAVI hospitals.

Keywords: Mortality; Outcomes; Readmission; TAVI; TAVR; Transcatheter aortic valve implantation.