UBC Theses and Dissertations
An exploratory analysis of factors associated with length of stay following transcatheter aortic valve implantation Nguyen, Michelle
Background: Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment option for higher surgical risk patients with severe symptomatic aortic stenosis (AS) and significant co-existing conditions which may preclude them from surgical valve replacement. Patient characteristics and wait time have been shown to impact length of stay (LOS) in individuals with heart disease; however, these variables have not been extensively evaluated in the TAVI population. Objective: The purpose of this study was to explore factors associated with post-TAVI recovery, as measured by hospital LOS. Method: A retrospective chart review of consecutive patients who underwent TAVI in Vancouver, British Columbia between January 01, 2013 to December 31, 2014 was conducted. Study variables included patient characteristics and wait time. The outcome variable, LOS, was defined as time, in days, from procedure to hospital discharge. Univariate and bivariate analyses were used to select moderately correlated variables for multivariate regression analysis. Results: The study sample consisted of 257 patients, with a mean age of 81.4 years. The median wait time from acceptance to procedure was 36 days, while the median LOS was 3.0 days. Bivariate analysis showed age, living situation, symptom severity, prior surgical aortic valve replacement (SAVR), and prior balloon aortic valvuloplasty (BAV) to be statistically significantly associated with post-TAVI stay in-hospital. The multivariate model revealed that relative to having a LOS of 1 to 2 days, patients who had previously undergone a BAV were 10.7 times more likely to stay 5 days or more (CI [1.16, 98.1]) compared with patients who had not undergone a BAV. No other baseline factors were found to be statistically predictive of prolonged LOS, although odds ratios suggest patients with lower symptom severity and patients who underwent valve-in-valve TAVI were less likely to experience a longer LOS. The model also showed that patients 75 to 79 years of age, with NYHA class III or IV symptoms, and no prior history of an AVR were more likely to follow a standard course of recovery, staying 3 to 4 days, while patients who had a valve-in-valve procedure were more likely to stay 1 to 2 days.
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