PloS one · 2021
Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis.
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Hadaya Joseph, Tran Zachary, Sanaiha Yas, Aguayo Esteban, Dobaria Vishal, Calfon Press Marcella, Benharash Peyman
Аннотация
BACKGROUND: Treatment options for mitral regurgitation range from diuretic therapy, to surgical and interventional strategies including TMVR in high-risk surgical candidates. Frailty has been associated with inferior outcomes following hospitalizations for heart failure and in open cardiac surgery.
OBJECTIVE: The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR).
METHODS: Adults undergoing TMVR were identified using the 2016-2018 Nationwide Readmissions Database, and divided into Frail and Non-Frail groups. Frailty was defined using a derivative of the Johns Hopkins Adjusted Clinical Groups frailty indicator. Generalized linear models were used to assess the association of frailty with in-hospital mortality, complications, nonhome discharge, hospitalization costs, length of stay, and non-elective readmission at 90 days. Average marginal effects were used to quantify the impact of frailty on predicted mortality.
RESULTS: Of 18,791 patients undergoing TMVR, 11.6% were considered frail. The observed mortality rate for the overall cohort was 2.2%. After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2-2.6), corresponding to an absolute increase in risk of mortality of 1.1%. Frailty was associated with a 2.7-day (95% CI 2.1-3.2) increase in postoperative LOS, and $18,300 (95% CI 14,400-22,200) increment in hospitalization costs. Frail patients had greater odds (4.4, 95% CI 3.6-5.4) of nonhome discharge but similar odds of non-elective 90-day readmission.
CONCLUSIONS: Frailty is independently associated with inferior short-term clinical outcomes and greater resource use following TMVR. Inclusion of frailty into existing risk models may better inform choice of therapy and shared decision-making.
OBJECTIVE: The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR).
METHODS: Adults undergoing TMVR were identified using the 2016-2018 Nationwide Readmissions Database, and divided into Frail and Non-Frail groups. Frailty was defined using a derivative of the Johns Hopkins Adjusted Clinical Groups frailty indicator. Generalized linear models were used to assess the association of frailty with in-hospital mortality, complications, nonhome discharge, hospitalization costs, length of stay, and non-elective readmission at 90 days. Average marginal effects were used to quantify the impact of frailty on predicted mortality.
RESULTS: Of 18,791 patients undergoing TMVR, 11.6% were considered frail. The observed mortality rate for the overall cohort was 2.2%. After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2-2.6), corresponding to an absolute increase in risk of mortality of 1.1%. Frailty was associated with a 2.7-day (95% CI 2.1-3.2) increase in postoperative LOS, and $18,300 (95% CI 14,400-22,200) increment in hospitalization costs. Frail patients had greater odds (4.4, 95% CI 3.6-5.4) of nonhome discharge but similar odds of non-elective 90-day readmission.
CONCLUSIONS: Frailty is independently associated with inferior short-term clinical outcomes and greater resource use following TMVR. Inclusion of frailty into existing risk models may better inform choice of therapy and shared decision-making.