P340. The Impact of Using Home Health Care After Thoracic Endovascular Aortic Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
UPMC
Pittsburgh, PA
United States - Contact Me
Danial Ahmad is a Postdoctoral Associate in the division of cardiac surgery, department of cardiothoracic surgery at University of Pittsburgh. His current research interests are aortic diseases with a special focus on the thoracic aorta as well as structural heart disease.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Home health care (HHC) may help reduce the burden on patients and families after interventions and potentially reduce hospital length of stay (LOS). We sought to assess outcomes of patients undergoing Thoracic Endovascular Aortic Repair (TEVAR) who were discharged with or without HHC services.
Methods: This was a retrospective analysis, using the Nationwide Readmissions Database (NRD), of TEVAR patients (2010 to 2018) who were categorized based on disposition at discharge into either the HHC cohort or the routine cohort. Propensity matching was utilized to compare the cohorts in addition to stepwise-weighted logistic regression.
Results: Of the 9170 TEVAR patients included, 27.3% (2500/9170) were discharged to HHC. Median age was 71 years (62-78) and women comprised 45.9% of the population with no differences between the groups.
Post-TEVAR rates of heart failure (HF) (4.3% vs. 2.7%, p<0.01), pneumonia (7.2% vs. 5%, p<0.01), ileus (4% vs. 2.8%, p=0.02), sepsis (1.6% vs. 0.9%), and hemorrhage (26.4% vs. 23.7%, p=0.03) were higher in the HHC cohort. The LOS for the index admission was comparable (7 days [5-12] vs. 6 days [3-12], p=0.09) as were the 30-day readmission (21.3% vs.19.6%, p=0.07) and 30-day mortality (0.17% vs. 0.25%, p=0.53) rates.
On weighted stepwise logistic regression (Table), HHC status (Odds Ratio (OR): 1.21 [95% CI: 1.11-1.32], p<0.001), female gender (0.87 [0.80-0.94], p<0.001), resident status (1.78 [1.54-2.04], p<0.001), non-elective procedure (1.62 [1.49-1.77], p<0.001), myocardial infarction (1.31 [1.18-1.44], p<0.001), arrhythmia (1.13 [1.03-1.25], p=0.01), and spinal cord ischemia (1.98 [1.26-3.10], p<0.001) were associated with 30-day readmission. Following propensity matching, HHC status did not show statistically significant association with 30-day readmission (HHC vs not: OR=1.14, 0.98-1.31, P=0.07)
Conclusion: Post-TEVAR utilization of HHC services was likely due to higher in hospital complications and trended toward association with increased odds of 30-day readmissions after propensity matching. Therefore, priority should be given to reducing TEVAR-related in-hospital complications as that may reduce HHC utilization and improve overall outcomes.
Authors
Danial Ahmad (1), Sarah Yousef (2), James Brown (1), Derek Serna-Gallegos (3), Carlos Diaz-Castrillon (4), Floyd Thoma (1), Yisi Wang (1), Michel Pompeu Sá (5), Ibrahim Sultan (3)
Institutions
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh, United States, (5) PROCAPE / University of Pernambuco, Recife, Pernambuco
Methods: This was a retrospective analysis, using the Nationwide Readmissions Database (NRD), of TEVAR patients (2010 to 2018) who were categorized based on disposition at discharge into either the HHC cohort or the routine cohort. Propensity matching was utilized to compare the cohorts in addition to stepwise-weighted logistic regression.
Results: Of the 9170 TEVAR patients included, 27.3% (2500/9170) were discharged to HHC. Median age was 71 years (62-78) and women comprised 45.9% of the population with no differences between the groups.
Post-TEVAR rates of heart failure (HF) (4.3% vs. 2.7%, p<0.01), pneumonia (7.2% vs. 5%, p<0.01), ileus (4% vs. 2.8%, p=0.02), sepsis (1.6% vs. 0.9%), and hemorrhage (26.4% vs. 23.7%, p=0.03) were higher in the HHC cohort. The LOS for the index admission was comparable (7 days [5-12] vs. 6 days [3-12], p=0.09) as were the 30-day readmission (21.3% vs.19.6%, p=0.07) and 30-day mortality (0.17% vs. 0.25%, p=0.53) rates.
On weighted stepwise logistic regression (Table), HHC status (Odds Ratio (OR): 1.21 [95% CI: 1.11-1.32], p<0.001), female gender (0.87 [0.80-0.94], p<0.001), resident status (1.78 [1.54-2.04], p<0.001), non-elective procedure (1.62 [1.49-1.77], p<0.001), myocardial infarction (1.31 [1.18-1.44], p<0.001), arrhythmia (1.13 [1.03-1.25], p=0.01), and spinal cord ischemia (1.98 [1.26-3.10], p<0.001) were associated with 30-day readmission. Following propensity matching, HHC status did not show statistically significant association with 30-day readmission (HHC vs not: OR=1.14, 0.98-1.31, P=0.07)
Conclusion: Post-TEVAR utilization of HHC services was likely due to higher in hospital complications and trended toward association with increased odds of 30-day readmissions after propensity matching. Therefore, priority should be given to reducing TEVAR-related in-hospital complications as that may reduce HHC utilization and improve overall outcomes.
Authors
Danial Ahmad (1), Sarah Yousef (2), James Brown (1), Derek Serna-Gallegos (3), Carlos Diaz-Castrillon (4), Floyd Thoma (1), Yisi Wang (1), Michel Pompeu Sá (5), Ibrahim Sultan (3)
Institutions
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh, United States, (5) PROCAPE / University of Pernambuco, Recife, Pernambuco
Presentation Duration
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