Sameer A Hirji# , Rohan M Shah# , Lily Saadat, Laura Piechura, Sary Aranki, Hari R Mallidi, Mark P Pelletier, Prem S Shekar, Tsuyoshi Kaneko*
Division of Cardiac Surgery, Brigham and Women’s Hospital; Harvard Medical School, Boston, MA, USA
*Corresponding author: Tsuyoshi Kaneko, Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis St, Boston MA, 02115, USA.
# Hirji SA, Shah RM contributed equally.
Received: November 11, 2019
Published: November 28, 2019
Introduction: Significant variability exists in disposition practices to non-home facilities following transcatheter aortic valve replacement (TAVR). Increased spending due to Post Acute Care Transfer (PACT) policies has led hospitals to scrutinize patient disposition following hospital discharge. We sought to examine the impact of admission origin on rehabilitative services use following TAVR.
Methods: The National Inpatient Sample was queried for TAVR procedures between 2012-2014. We further isolated patients who were discharged to a rehabilitation facility (skilled nursing facility, intermediate care facility, or other rehabilitation facility) stratified by admission origin. Multivariable logistic regression was used to determine independent predictors for disposition to a rehabilitation facility.
Results: A total of 12,175 TAVR patients were discharged to rehabilitation facilities. This included 10,520 patients (86.4%) who were admitted from home, 1,255 patients (10.3%) who were transferred from an acute care hospital, and 355 patients (2.9%) who were transferred from another health facility at the time of admission. Patients transferred from an acute hospital had higher inpatient costs ($77,092 vs. $66,507 and $64,861) and longer length of stay (17.2 vs. 11.6 and 10.6 days; all p < 0.05) compared to those transferred from a non-acute facility and those not transferred, respectively. Weekend admission (odds ratio [OR]= 1.78, 95% confidence interval [CI]: 1.11 to 2.84; p=0.017), non-elective admission (OR= 8.23, 95% CI: 4.15 to 13.16; p<0.001), and transfer from a non-acute facility (OR 4.32, 95% CI: 1.74 to 10.67; p=0.002) were independent predictors for disposition to a rehabilitation facility.
Conclusions: Admission origin appears to impact the likelihood of requiring rehabilitation services following TAVR, independent of academic status and patient comorbidities. Drivers propagating non-home discharge, such as weekend transfers from non-acute facilities and non-elective cases, should be investigated to optimize hospital resource utilization under current PACT policies.
Keywords: Transcatheter Aortic Valve Replacement; Post-Acute Care Transfer; Aortic Valve Treatment; Surgical Aortic Valve Replacement