Abstract 065: Hospital Teaching Status and TAVR Outcomes in the United States - Analysis of the National Inpatient Sample (NIS)

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Abstract

Background: Evidence suggest that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing TAVR

Methods: This study was conducted using the National Inpatient Sample (NIS) in the U.S (2011-2013). Teaching status was classified as teaching vs non-teaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model

Results: An estimated 17,020 TAVR procedures were performed in the U.S between 2011 and 2013, out of which 87% were in teaching hospitals. Mean (SD) age was 80 (8) and 47% were females. There was no significant difference between hospital teaching status with regards to procedure-related in-patient mortality, myocardial infarction, or other cardiac, vascular, neurological, respiratory complications, post-op DVT/PE, or sepsis (Fig 1). However, compared to non-teaching hospitals, teaching hospitals tend to have higher risk of acute kidney injury (OR: 1.47 [95% CI, 1.08-1.99]) but lower risk of hemorrhage requiring transfusion (OR: 0.67 [95% CI, 0.50-0.91]). The mean length of stay was higher in teaching hospitals (8.3 days) compared to non-teaching hospitals (7.5 days) (fig 2A), but median cost of hospitalization was higher in non-teaching hospitals (USD 59702 vs 49708) (fig 2B)

Conclusion: We found that the risks of most TAVR-related complications (except for AKI and hemorrhage) are about the same in teaching compared to non-teaching hospitals. However, length of stay was higher in teaching hospitals while cost was higher in non-teaching hospitals

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