Thirty-Day Readmissions after Early versus Delayed Discharge after Uncomplicated Transcatheter Aortic Valve Replacement: Insights from the Nationwide Readmissions Database
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Early discharge after transcatheter aortic valve replacement (TAVR) has generally shown to be safe; however, studies have been limited to single centers or trial populations, making their generalizability unclear. This study sought to examine the rate of rehospitalization after early vs. late discharge following uncomplicated TAVR in an unselected population, to explore the variability in early discharge across sites, and to investigate factors associated with failure of early discharge. Using the National Readmission Databases (1/2014-9/2015), we compared 30-day readmission rates between early (<3 days) vs late (≥3 days) discharges after uncomplicated transfemoral TAVR (propensity matched cohort) using Kaplan-Meier methods. Additionally, we examined factors associated with failure of early discharge using logistic regression and testing for interactions of patient factors with discharge strategy. Among 4,955 hospitalizations for uncomplicated TAVR, 1857 (37%) were discharged early with substantial site-level variability (range 0-87%; median odds ratio 3.69). In the propensity matched cohort (n=3346), there were similar rates of 30-day readmission by discharge strategy (early vs. late: 10.3% vs. 10.6%; stratified log-rank p=0.555). There was a statistically significant interaction between discharge strategy and number of chronic conditions (p=0.007), where readmission rates were lower in patients discharged early versus late. In a matched cohort of real-world patients, early discharge after uncomplicated TAVR was not associated with a higher rate of 30-day rehospitalization, yet there was significant variability in early discharge across US hospitals. Furthermore, we were unable to identify any patients who appeared to benefit for longer inpatient monitoring. Novel strategies should be explored to safely increase the rate of early discharge after uncomplicated TAVR to improve patient outcomes.