Risk scoring model for prediction of non-home discharge after transcatheter aortic valve replacement


Okoh A. K. , ÖZTÜRK E., Gold J., Siddiqui E., Dhaduk N., Haik B., ...More

JOURNAL OF GERIATRIC CARDIOLOGY, vol.17, no.10, pp.621-627, 2020 (Peer-Reviewed Journal) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 17 Issue: 10
  • Publication Date: 2020
  • Doi Number: 10.11909/j.issn.1671-5411.2020.10.002
  • Journal Name: JOURNAL OF GERIATRIC CARDIOLOGY
  • Journal Indexes: Science Citation Index Expanded, Scopus, EMBASE
  • Page Numbers: pp.621-627
  • Keywords: Aortic valve replacement, Non-home discharge, Postoperative risk, Transcatheter, Transfemoral, QUALITY-OF-LIFE, OUTCOMES, SURGERY, FRAILTY

Abstract

Background Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients (97%) who were discharged alive, the incidence of non-home discharge was 25.6% (n = 289). The patient population was randomly divided into the 80% (n = 900) derivation cohort and 20% (n = 226) validation cohort. Mean +/- SD age of the study population was 83 +/- 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.