Temporal trends in the utilization, costs, and outcomes of concomitant left atrial appendage closure across a statewide collaborative

Abstract

Objective

With the rising incidence of atrial fibrillation, left atrial appendage closure (LAAC) at the time of cardiac surgery remains an important adjunct. The present study characterized trends, associated resource utilization, and potential disparities in the use of left atrial appendage exclusion.

Methods

Using a Society of Thoracic Surgeons regional academic collaborative database, we queried all adult patients undergoing coronary and valve procedures with concomitant LAAC between 2015 and 2021. Trends in LAAC, as well as the technique for closure, were evaluated. Multilevel hierarchical logistic modeling was applied to delineate factors associated with LAAC, accounting for patient and operative characteristics. Generalized linear models were developed to perform risk-adjusted incremental cost analysis.

Results

Of the 8699 patients who met the study criteria, 1377 underwent left atrial appendage closure. Over the study period, the annual rate of LAAC increased from 16.7% to 30.8% (P < .001). LAAC patients were older, but less commonly insulin-dependent diabetics or on dialysis. Female sex, redo, and urgent operative status had lower risk-adjusted odds of LAAC. Although LAAC was associated with longer bypass time, there was no significant association with 30-day mortality or 30-day readmission. LAAC was associated with an incremental increase in adjusted costs by $10,602 (95% confidence interval, $4078-$17,126).

Conclusions

Rates of LAAC are increasing but less common among female patients, as well as those requiring urgent/emergent interventions. LAAC did not significantly impact short-term mortality. Our results suggest that LAAC may be a high-value intervention among patient populations that have the greatest potential to derive its benefits.