Abstract
BackgroundOlder patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals.MethodsWe included 100% of Medicare Fee-for-Service patients ≥65 years of age who underwent MVS between 1999–2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race).ResultsThe 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999–2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65–74: 47.4% to 44.4%; 75–84: 51.4% to 49.2%, ≥85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18).ConclusionsAmong older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.
Highlights
Mitral valve disease is common in older adults [1]
The post-mitral valve surgery (MVS) 1-year readmission rate declined from 1999–2010 (49.5% to 46.9%, P
There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks
Summary
Mitral valve disease (most often regurgitation) is common in older adults [1]. In the subset of patients with severe symptomatic mitral regurgitation, definitive therapy involves repair or replacement of the mitral valve. Our group [2] and others [3] have shown a significant decline in U.S mortality rates after mitral valve surgery (MVS) over time; for example, in Medicare beneficiaries 65 years undergoing isolated MVS over a 10-year period, risk-adjusted mortality declined by 40%, and by 2008 seven out of every eight patients undergoing MVS were alive at 1 year [2]. While this trend is encouraging, as the vast majority of MVS patients survive, mortality statistics reveal little about the heterogeneity of experience among survivors. Our objective was to determine trends in 1year hospital readmission rates and length of stay (LOS) in these individuals
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