Interhospital Readmissions and Early Post-Discharge Outcomes of Transcatheter Mitral Valve Edge-to-Edge Repair

Abstract

IntroductionFragmented postoperative care following elective procedures has been associated with poor outcomes. However, the association between interhospital readmission (IHR) and clinical outcomes after transcatheter edge-to-edge repair (TEER) is unknown. MethodsAdults who underwent TEER between 2014 and 2018 were identified in the National Readmission Database (NRD). We classified patients who were re-hospitalized within 90-days after TEER as: patients admitted to the index hospital (same hospital readmission; SHR) and those admitted to a different hospital (interhospital readmission; IHR). We compared 90-day outcomes, cause of readmission, length of stay (LOS), and costs between the two groups. Moreover, we tested whether IHR was an independent predictor of 180-day morality using logistic regression. ResultsOf the 12,716 patients who underwent TEER, 2444 were hospitalized within 90-days; among those, 1179 (48.2%) were admitted to a different hospital (IHR). Cardiovascular causes of readmission were more common in the SHR group (63.5% vs 56.7%, P < 0.001). After PSM, major adverse events were higher in the SHR group during both the index admission and during rehospitalization. Also, during the readmission, LOS and cost of care were both higher in the SHR group, while non-home discharge rates were higher in the IHR group. In the logistic regression model, IHR was not independently associated with 180-day mortality. ConclusionAdmission to a different hospital post TEER was not associated with higher adverse event rate. The current system of care wherein patients requiring TEER are referred to tertiary centers of excellence appears appropriate.