Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-216 - Thirty-day Readmissions After Percutaneous Left Atrial Appendage Closure In The United States: Insights From The Nationwide Readmissions Database (ID 259)

Abstract

Background: Percutaneous left atrial appendage closure (pLAAC) has emerged as an alternate option for stroke prevention in patients with atrial fibrillation ineligible for long-term anticoagulation. Real-world data on pLAAC is lacking.
Objective: We aimed to determine predictors of in-hospital mortality and 30-day readmission in patients undergoing pLAAC.
Methods: The study cohort consisted of patients who underwent pLAAC in 2014, identified from National Readmission Database, a resource of the Healthcare Cost and Utilization Project developed by Agency for Healthcare Research and Quality. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. If patients had more than one readmission within 30 days, only the first readmission was included.
Results: Among 5272 pLAAC procedures, the in-hospital mortality was 0.2% (n = 11) and median length of stay was 1 day (IQR 1-2 days). There were 5.61% procedure related complications - pericardial (3.53%, of which 0.42% required intervention) and infectious complication (1.04%) being the most common. 30-day readmission rate was 1.1% (n = 58) with respiratory failure (17.65% - including pneumonia or chronic obstructive pulmonary disease exacerbation) and heart failure syndrome (11.76%) being the most common readmission etiology. Any procedure related complications was an independent predictor of in-hospital mortality (OR 6.06, 95% CI 1.15-31.88, p = 0.03) and increased length of stay (OR 3.4, 95% CI 2.9-3.8, p < 0.001). Increased length of stay was an independent predictor of 30-day readmission (2 midnights OR 7.57, 95% CI 2.84-20.19, p<0.001 while 3 or more midnights OR 15.74, 95% CI 6.55-37.81, p<0.001). Any procedure related complication on the contrary did not reach any statistical significance (OR 1.34, 95% 0.53 - 3.37, p = 0.53).
Conclusion: Procedure and patient related factors were identified as predictors of in-hospital mortality and 30-day readmission, respectively; the knowledge of which can potentially improve health-care delivery and potentially reduce health care cost.
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