Hospital intervention volume affects outcomes of emergency transcatheter aortic valve implantations in Germany

• Verfasst von: Oettinger, Vera [VerfasserIn]
• Verfasst von: Heidenreich, Adrian [VerfasserIn]
• Verfasst von: Kaier, Klaus [VerfasserIn]
• Verfasst von: Zehender, Manfred Karl-Heinz [VerfasserIn]
• Verfasst von: Bode, Christoph [VerfasserIn]
• Verfasst von: Dürschmied, Daniel [VerfasserIn]
• Verfasst von: Zur Mühlen, Constantin von [VerfasserIn]
• Verfasst von: Westermann, Dirk [VerfasserIn]
• Verfasst von: Stachon, Peter [VerfasserIn]
• Titel: Hospital intervention volume affects outcomes of emergency transcatheter aortic valve implantations in Germany
• Verf.angabe: Vera Oettinger, Adrian Heidenreich, Klaus Kaier, Manfred Zehender, Christoph Bode, Daniel Duerschmied, Constantin von zur Mühlen, Dirk Westermann and Peter Stachon
• E-Jahr: 2022
• Jahr: 19 October 2022
• Umfang: 7 S.
• Fussnoten: Gesehen am 15.08.2023
• Titel Quelle: Enthalten in: Scientific reports
• Ort Quelle: [London] : Springer Nature, 2011
• Jahr Quelle: 2022
• Band/Heft Quelle: 12(2022), Artikel-ID 17483, Seite 1-7
• ISSN Quelle: 2045-2322
• DOI: doi:10.1038/s41598-022-20336-y
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Cardiology
• Sach-SW: Health care economics
• Sach-SW: Interventional cardiology
• Sach-SW: Outcomes research
• K10plus-PPN: 1856200329

Abstract

The literature has shown an inverse volume-outcome relationship for transcatheter aortic valve implantation (TAVI). However, little is known about emergency admissions in Germany. Using German national electronic health records, we identified all isolated balloon-expandable and self-expanding transfemoral TAVI in 2018. The focus was on those patients with emergency admission. 17,295 patients were treated with TAVI, including 1682 emergency cases. 49.2% of the emergency admissions were female, the mean age was 81.2 years and the logistic EuroSCORE was 23.3%. The percentage of emergency cases was higher in lower volume than in higher volume centers (p < 0.001): In detail, centers performing < 50 TAVI showed an emergency admission rate of ~ 15%, those with > 200 TAVI a rate of ~ 11%. After propensity score adjustment, analyzing the outcomes for an increase in volume per 10 emergency admissions, higher volume centers showed significantly better outcomes regarding in-hospital mortality (OR = 0.872, p = 0.043), major bleeding (OR = 0.772, p = 0.001), stroke (OR = 0.816, p = 0.044), mechanical ventilation > 48 h (OR = 0.749, p = 0.001), length of hospital stay (risk adjusted difference in days of hospitalization per 10 emergency admissions: − 1.01 days, p < 0.001), and reimbursement (risk adjusted difference in reimbursement per 10 emergency admissions: -€314.89, p < 0.001). Results were not significant for acute kidney injury (OR = 0.951, p = 0.104), postoperative delirium (OR = 0.975, p = 0.480), and permanent pacemaker implantation (OR = 1.010, p = 0.732). In conclusion, regarding transfemoral TAVI, the percentage of emergency cases was higher in lower volume centers in Germany. However, higher volume centers show significantly better outcomes for in-hospital mortality and complication rates as well as resource utilization parameters.