Hospital practice of direct-home discharge and 30-day readmission after transcatheter aortic valve replacement in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) registry

Background--nearly 17% of patients are readmitted within 30 days of discharge after transcatheter aortic valve replacement. selected patients are discharged to skilled nursing facilities,yet the association between a hospital's practice to discharge home versus to skilled nursing facilities,and readmission remains unclear. methods and results--the society of thoracic surgeons/american college of cardiology transcatheter valve therapy (sts/acc tvt) registry was used to evaluate readmissions among patients undergoing transcatheter aortic valve replacement (2011-2015). hospitals were divided into quartiles (q1-q4) based on the percentage of patients discharged directly home. we assessed patient and hospital level characteristics and used hierarchical logistic regression to analyze the association of discharge disposition with 30-day readmission. our cohort included 18 568 transcatheter aortic valve replacement patients at 329 us hospitals,of whom 69% were discharged directly home. hospitals in the highest quartile of direct home discharge (q4) compared with hospitals in the lowest (q1) were more likely to use femoral access (75.2% versus 60.1%,p < 0.001),had fewer patients receiving transfusion (26.4% versus 40.9%,p < 0.001),and were more likely to be located in the southern united states (48.8% versus 18.3%,p < 0.001). median 30-day readmission rate was 17.9%. there was no significant difference in 30-day readmissions among quartiles (p=0.14),even after multivariable adjustment (odds ratio q4 versus q1=0.89,95%ci 0.76-1.04; p=0.15). factors most strongly associated with 30-day readmission were glomerular filtration rate,in-hospital stroke or transient ischemic attack,and nonfemoral access. conclusions--there was no statistically significant association between hospital practice of direct home discharge post- transcatheter aortic valve replacement and 30-day readmission. further research is needed to understand regional variations and optimum strategies for postdischarge care. © 2017 the authors and medtronic.