In-hospital resource utilization in surgical and transcatheter aortic valve replacement

BMC Cardiovascular Disorders

Research Article

Werner Vach¹  Martin Moser²  Anja Gutmann²  Annette Geibel²  Andreas Zirlik²  Christoph Bode²  Jochen Reinöhl²  Manfred Zehender²  Constantin von zur Mühlen²  Klaus Kaier³  Matthias Siepe⁴  Stefan Sorg⁴  Friedhelm Beyersdorf⁴  Hardy Baumbach⁵  Philipp Blanke⁶ 

[1]Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg, Germany

[2]Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany

[3]Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany

[4]Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg, Germany

[5]Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany

[6]Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany

[7]Department of Diagnostic Radiology, Medical Center-University of Freiburg, Freiburg, Germany

关键词: Transcatheter aortic valve implantation;    Aortic valve replacement;    Resource utilization;    Risk prediction;    Cost;    Length of stay;    Total hospitalization since procedure;   

DOI  :  10.1186/s12872-015-0118-x

 received in 2015-05-13, accepted in 2015-09-30,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundLittle is known about preoperative predictors of resource utilization in the treatment of high-risk patients with severe symptomatic aortic valve stenosis. We report results from the prospective, medical-economic “TAVI Calculation of Costs Trial”.MethodsIn-hospital resource utilization was evaluated in 110 elderly patients (age ≥ 75 years) treated either with transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation (TAVI, N = 83), or surgical aortic valve replacement (AVR, N = 27). Overall, 22 patient-specific baseline parameters were tested for within-group prediction of resource use.ResultsBaseline characteristics differed between groups and reflected the non-randomized, real-world allocation of treatment options. Overall procedural times were shortest for TAVI, intensive care unit (ICU) length of stay (LoS) was lowest for AVR. Length of total hospitalization since procedure (THsP) was lowest for TF-TAVI; 13.4 ± 11.4 days as compared to 15.7 ± 10.5 and 21.2 ± 15.4 days for AVR and TA-TAVI, respectively. For TAVI and AVR, EuroScore I remained the main predictor for prolonged THsP (p <0.01). Within the TAVI group, multivariate regression analyses showed that TA-TAVI was associated with a substantial increase in THsP (55 to 61 %, p <0.01). Additionally, preoperative aortic valve area (AVA) was identified as an independent predictor of prolonged THsP in TAVI patients, irrespective of risk scores (p <0.05).ConclusionsOur results demonstrate significant heterogeneity in patients baseline characteristics dependent on treatment and corresponding differences in resource utilization. Prolonged ThsP is not only predicted by risk scores but also by baseline AVA, which might be useful in stratifying TAVI patients.Trial registrationGerman Clinical Trial Register Nr. DRKS00000797

【 授权许可】

CC BY   
© Reinöhl et al. 2015