Predictors of length of hospital stay and impact of a TAVI program on management and outcomes of patients undergoing transcatheter aortic valve implantation

Abstract

Background The number of transcatheter aortic valve implantation (TAVI) procedures in patients with severe aortic stenosis (AS) is increasing worldwide. We aimed to assess the impact of a TAVI program on clinical profile, management and outcomes of these patients and to describe predictors of length of hospital stay (LoS) in this context. Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge (January 2018-December 2022). A TAVI program was implemented in may 2021. Baseline clinical characteristics, management and in-hospital complications were registered. Predictors of long hospital stay (> 7 day) were assessed by binary logistic regression. Results We included 614 patients, with mean age 80.5 years. Most patients (438/614, 71.2%) presented conditions that precluded an early discharge. Mean hospital stay was 7.6 days. Patients admitted after the implementation of the program had a significantly lower burden of comorbidities. The rate of conduction disturbances after TAVI remained stable around 60%. However, permanent pacemaker requirement declined from 30.3% to 22.5% (P = 0.028). LoS was reduced after the implementation of the program both in patients suitable for an early discharge (from 6.5 day to 4 day, P < 0.001) and unsuitable patients (from 9.4 day to 7.7 day, P = 0.014). The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases, day of the week, emergent procedures, and conduction disturbances and other complications as independent predictors of long stay after TAVI. Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge. The implementation of a TAVI program improved selection of patients, with a lower burden of comorbidities, a lower rate of complications and a marked reduction of hospital stay.