Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis

Stein Ove Danielsen; Philip Moons; Irene Sandven; Marit Leegaard; Svein Solheim; Theis Tønnessen; Irene Lie

doi:10.1016/j.ijcard.2018.05.026

Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis

Int J Cardiol. 2018 Oct 1:268:85-91. doi: 10.1016/j.ijcard.2018.05.026. Epub 2018 May 18.

Authors

Stein Ove Danielsen¹, Philip Moons², Irene Sandven³, Marit Leegaard⁴, Svein Solheim⁵, Theis Tønnessen⁶, Irene Lie⁷

Affiliations

¹ Centre for Patient-centered Heart and Lung research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium. Electronic address: steinda@uio.no.
² KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
³ Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
⁴ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
⁵ Center for Clinical Heart Research and Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.
⁶ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
⁷ Centre for Patient-centered Heart and Lung research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.

PMID: 29779575
DOI: 10.1016/j.ijcard.2018.05.026

Abstract

Background: The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a systematic review and meta-analysis to examine the overall incidence, causes, and risk factors of 30-day all-cause readmission rate after SAVR and TAVR.

Methods: Eight medical research databases were searched; Cochrane, Medline, Embase, UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.

Results: Thirty-three articles were included in the systematic review, 32 of which were appropriate for the meta-analysis. Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95% CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart failure, arrhythmia, infection, and respiratory problems were the most frequent causes of all-cause readmission after SAVR and TAVR. Most frequent reported prior risk factors for all-cause readmission following TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney problems, and transapical approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause readmission were reported in the literature to date.

Conclusion: In conclusion, the overall proportion of 30-day all-cause readmission after SAVR and TAVR are high. Interventions to prevent avoidable readmissions ought to be developed and implemented.

Keywords: Aortic stenosis; Surgical aortic valve replacement; Thirty-day readmission; Transcatheter aortic valve replacement.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Cohort Studies
Humans
Patient Readmission / trends*
Postoperative Complications / diagnosis
Postoperative Complications / etiology*
Postoperative Complications / therapy
Prospective Studies
Time Factors
Transcatheter Aortic Valve Replacement / adverse effects*
Transcatheter Aortic Valve Replacement / trends*
Treatment Outcome