PCV12 - Hospitalization Outcomes For Adults In The United States With Atrial Septal Defect: Analysis Of A Multicenter Database

Abstract

Atrial Septal Defect (ASD) closure in the elderly has been a topic of debate. Some experts suggest closure of ASD in the elderly, others believe risks outweigh benefits. The objectives of this study is to assess trends of ASD closure in the US between 2000 and 2012, and patient characteristics and outcomes for ASD closure in adults (16 to 59 years) and elderly adults (>60 years). The Nationwide Inpatient Sample was used to identify patients above 16 years of age who underwent transcatheter device closure (closed technique) and surgical closure (open technique) for ASD repair. ICD-9 codes were used to identify the study sample between 2000 and 2012. Risk factors for mortality in the 16-59 years age group and ≥ 60 years age group were determined based on clinical characteristics and comorbidities. Predictors for hospitalization outcomes including death, prolonged length of stay, and discharge to a skilled nursing facility were calculated. There were 11,018 cases of ASD repair in the US between 2000 and 2012. In the ≥ 60 years age group, there is a declining trend in closed technique (p <0.01) between 2006 (n = 1667) and 2012 (n = 920) and open technique (p<0.01) between 2009 (n=342) and 2012 (n=240). Unadjusted analyses revealed significant difference in mortality (0.57% vs 1.42%; p<0.05), length of stay (2.78 days vs 8.18 days; p < 0.001), and discharge to a skilled nursing facility (4.08% vs 67.14%; p<0.001) between closed technique vs open technique. Significant risk factors for mortality in closed technique included vascular complications due to procedure, previous myocardial infarction and acute kidney injury. Procedure volume of both – open technique and closed technique have increased since 2000. Mortality in open technique is three times that of closed technique (p<0.01).