Risk scoring model for prediction of non-home discharge after transcatheter aortic valve replacement

作     者：Alexis K Okoh Ebru Ozturk Justin Gold Emaad Siddiqui Nehal Dhaduk Bruce Haik Chun-Guang CHEN Marc Cohen Mark J Russo Alexis K Okoh;Ebru Ozturk;Justin Gold;Emaad Siddiqui;Nehal Dhaduk;Bruce Haik;Chun-Guang CHEN;Marc Cohen;Mark J Russo

作者机构：Cardiovascular Outcomes Research InstituteRWJ Barnabas Health-NBIMCNewarkNew JerseyUSA Department of MedicineDivision of BiostatisticsHacettepe UniversityAnkaraTurkey Rutgers New Jersey Medical SchoolNewarkNew JerseyUSA Department of SurgeryDivision of Cardiothoracic SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2020年第17卷第10期

页      面：621-627页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Aortic valve replacement Non-home discharge Postoperative risk Transcatheter Transfemoral 

摘      要：Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.