Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement

Sheikh, M. A., Deo, S. V. , Riaz, H., Raza, S., Altarabsheh, S. E., Wilson, B., Elgudin, Y., Cmolik, B., Pelletier, M. and Markowitz, A.H. (2021) Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement. Catheterization and Cardiovascular Interventions, 97(3), E425-E430.

Abstract

Objective: To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). Background SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. Methods: Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. Results: Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98–1.007); p = .43], stroke [OR 1.009(0.99–1.02); p = .08], acute kidney injury [OR 0.99(0.96–1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. Conclusion: Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Deo, Salil
• Authors: Sheikh, M. A., Deo, S. V., Riaz, H., Raza, S., Altarabsheh, S. E., Wilson, B., Elgudin, Y., Cmolik, B., Pelletier, M., and Markowitz, A.H.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Catheterization and Cardiovascular Interventions
• Publisher: Wiley
• ISSN: 1522-1946
• ISSN (Online): 1522-726X
• Published Online: 18 July 2020