Incidence and Causes of 30-day Readmissions after Surgical Versus Percutaneous Secundum Atrial Septal Defect Closure: A United States Nationwide Analysis

Abstract

ABSTRACT Background: The preferred approach for secundum atrial septal defect (ASD) closure has evolved from surgical repair to the current standard of practice being percutaneous closure. Although studies have highlighted a reduction in procedural complications with the percutaneous method, there is a paucity of data on readmissions after ASD closure. We evaluated the incidence and reasons for 30-day hospital readmissions in patients undergoing secundum ASD repair via surgical versus percutaneous approach. Methods: Data for hospitalizations for surgical or percutaneous closure of secundum ASD, during the years 2013–2014, were obtained from the Nationwide Readmissions Database (NRD). Hospitalization characteristics and relevant comorbidities were identified using the corresponding International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-CM 9] codes. Propensity score matching was conducted to evaluate the 30-day rates and causes of readmission following surgical repair compared with percutaneous closure. Results: Of 4,616 hospital stays for adult patients undergoing ASD closure (3,004 percutaneous and 1,612 surgical), 163 were readmitted within 30 days from their index hospitalization. The unadjusted incidence of readmission was higher in the surgical group (5.2% vs. 2.7%, OR = 1.99, 95% CI 1.08–3.69, p = 0.028). Atrial fibrillation/flutter and post-pericardiotomy syndrome were the most common reasons for readmission after percutaneous and surgical closures, respectively. Patients who underwent surgical ASD repair had a higher median length of stay (8.8 vs. 5.2 days, p < 0.001) and cost of index hospitalization ($169,513 vs. $105,189, p < 0.001). Conclusions: Percutaneous ASD closure is associated with lower rates of 30-day readmissions, mean length of hospital stay, and hospital charges as compared with surgical closure.