Readmission Mortality After TAVR: The Combined Effect of Teaching Hospital Status and Cause of Readmission

Abstract

Background

Variability in transcatheter aortic valve replacement (TAVR) readmission rates highlights the importance of assessing post-discharge outcomes. Understanding how teaching hospital status and causes of readmission influence mortality could optimise post-TAVR care.

Methods

Using the National Readmissions Database, we identified 155,298 TAVR admissions from 2012 to 2020. We evaluated the interaction effect between teaching status and cause of readmission on readmission-related mortality through adjusted mixed-effects models.

Results

Overall, 18.9% of patients (n = 29,479) had a nonelective readmission within 90 days, with no significant difference between teaching and nonteaching hospitals (19.3% vs 18.9%; P > 0.05). Cardiac-related readmissions accounted for 42.7% of cases, while noncardiac readmissions made up 57.3%, with no differences observed in their distribution between teaching and nonteaching hospitals. The unadjusted 90-day readmission mortality rate was 3.8%, without significant differences between teaching and nonteaching hospitals (3.8% vs 4.1%; P = 0.38). A downward trend in nonelective readmission and readmission-related mortality rates was observed, regardless of teaching status. An interaction effect between teaching status and the cause of readmission was identified: Noncardiac readmissions to teaching hospitals were associated with increased odds of death (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.59-2.07; P < 0.001) compared with nonteaching hospitals, whereas cardiac readmissions to teaching hospitals were associated with decreased odds of in-hospital mortality (OR 0.55, 95% CI 0.48-0.62; P < 0.001).

Conclusion

Our findings indicate a differential association between teaching hospital status and 90-day readmission mortality, contingent on the cause of readmission. Further research, including the use of metrics such as failure to rescue, is needed to better understand the relationship between patient-level variables and teaching hospital status.