Abstract 15739: Utility of 30-Day Risk Adjusted Home Time as a Hospital Performance Metric for Transcatheter Edge-to-Edge Mitral Valve Repair

Abstract

Introduction: While the utilization of mitral valve transcatheter edge-to-edge repair (TEER) procedures continues to increase over time, a validated, patient-centered, hospital-level performance metric for TEER is lacking Hypothesis: We examined the utility of 30-risk adjusted home time (HT) as a hospital-level performance metric for TEER procedure and compared it with the established volume, 30-day readmission, and 30-day mortality-based measures. Methods: Medicare patients who received TEER from 2013 to 2019 were identified. HT is defined as time spent alive and out of a hospital, skilled nursing facility, or long-term facility 30 days after TEER. Hospital-level risk-standardized measures of 30-day HT, readmission (RSRR), and mortality (RSMR) were developed using standard risk-adjustment models and correlation between these performance metrics was estimated by Pearson correlation. Longer-term patient-level outcomes of 1-year mortality and readmission were also compared across quartiles of hospitals on 30-day HT. Results: Overall, 24,420 patients who underwent TEER in 344 hospitals were included (mean age 80 y, 54% men, 7% Black race). At the hospital level, the median risk-adjusted 30-day HT was 24 days. There was significant inverse correlation between risk adjusted 30-day HT and 30-day RSRR (r=-0.43), 30-day RSMR (r=-0.5), and modest correlation with hospital’s annual TEER volume (r=0.11, P=0.05). The 1-year readmission and mortality among patients undergoing TEER decreased across increasing 30-day HT categories (Figure). 30-day HT (vs. annual TEER volume) meaningfully reclassified hospital performance in 34% of the hospitals with lower 1-year mortality and readmission among hospitals that were up classified (vs. no change) in performance ranking. Conclusions: Risk-adjusted 30-day HT is a patient-centered, comprehensive quality metric to assess hospital performance in TEER that correlates with important short- and long-term outcomes.