Hospitals Performing TAVR Keep Readmissions, Costs Low

Hospitals that perform a high volume of transcatheter aortic valve replacements (TAVRs) have significantly lower 30-day readmission rates than medium- and low-volume hospitals and, subsequently, are linked with much lower costs to the healthcare system, according to a study published online in JAMA Cardiology.

The study is the first to investigate an association between hospital TAVR volume and 30-day readmissions, according to researchers (JAMA Cardiol. Published online May 11, 2017. doi:10.1001/jamacardio.2017.1630).

“With the recent US Food and Drug Administration approval of the Edwards Sapien XT and Sapien 3 valves (Edwards Lifesciences) for intermediate surgical risk patients, the use of TAVR is expected to increase exponentially in the United States,” they wrote.

The observational study tapped the Nationwide Readmissions Database to find hospitals that performed at least 5 TAVRs in the first quarter of 2014. The 129 hospitals included in the study were categorized as low volume if they performed fewer than 50 TAVRs annually (15.5% of the hospitals in the analysis fell into this category), medium volume if they performed between 50 and 99 TAVRs annually (36.4%), and high volume if they performed 100 or more TAVRs annually (48.1%).

The study revealed an inverse association between hospital TAVR volume and 30-day readmissions. In fact, readmissions were 25% lower at high-volume hospitals compared with low-volume hospitals. Low-volume hospitals had a higher proportion of noncardiac readmissions (infections and respiratory issues), while high-volume hospitals had more cardiac-related readmissions.

Researchers found no significant differences in length of stay or costs per admission among hospitals.

“Although the cost of all readmissions was similar, lower readmission rates at high-volume hospitals equate to lower health care costs and substantial savings,” they pointed out.

A linked editorial called the study findings “provocative” but reminded readers the issue of readmissions following TAVR is more multifaceted and complex than simply the volume of procedures a hospital performs.

“For low-volume and higher-volume programs, the most constructive approach is to promote best practices and focus TAVR programs to analyze their outcomes including readmission rates, compare them with national benchmarks, and take actions that are likely to improve their performance and reduce unwanted outcomes such as readmissions,” wrote editorialist John D. Carroll, MD, of the University of Colorado Denver and Anchutz Medical Campus, Aurora.

—Jolynn Tumolo