Mortality, length of stay, and cost implications of procedural bleeding after percutaneous interventions using large-bore catheters

Björn Redfors, Brendan M. Watson, Thomas McAndrew, Emilie Palisaitis, Dominic P. Francese, Mehdi Razavi, Jordan Safirstein, Roxana Mehran, Ajay J. Kirtane, Philippe Généreux

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20 Citations (Scopus)

Abstract

IMPORTANCE Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity. OBJECTIVE To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016. MAIN OUTCOMES AND MEASURES Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications. RESULTS Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95%CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95%CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95%CI, 1.52-1.59; P < .001). CONCLUSIONS AND RELEVANCE Periprocedural bleedingwas common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.

Original languageEnglish (US)
Pages (from-to)798-802
Number of pages5
JournalJAMA Cardiology
Volume2
Issue number7
DOIs
StatePublished - Jul 2017
Externally publishedYes

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Length of Stay
Catheters
Hemorrhage
Costs and Cost Analysis
Mortality
Health Care Costs
Databases
Heart-Assist Devices
Hospital Mortality
Hematoma
Aneurysm
Inpatients
Linear Models
Cohort Studies
Retrospective Studies
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Morbidity
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, Björn ; Watson, Brendan M. ; McAndrew, Thomas ; Palisaitis, Emilie ; Francese, Dominic P. ; Razavi, Mehdi ; Safirstein, Jordan ; Mehran, Roxana ; Kirtane, Ajay J. ; Généreux, Philippe. / Mortality, length of stay, and cost implications of procedural bleeding after percutaneous interventions using large-bore catheters. In: JAMA Cardiology. 2017 ; Vol. 2, No. 7. pp. 798-802.
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abstract = "IMPORTANCE Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity. OBJECTIVE To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016. MAIN OUTCOMES AND MEASURES Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications. RESULTS Bleeding complications occurred in 3128 patients (17.7{\%}) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95{\%}CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95{\%}CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95{\%}CI, 1.52-1.59; P < .001). CONCLUSIONS AND RELEVANCE Periprocedural bleedingwas common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.",
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Mortality, length of stay, and cost implications of procedural bleeding after percutaneous interventions using large-bore catheters. / Redfors, Björn; Watson, Brendan M.; McAndrew, Thomas; Palisaitis, Emilie; Francese, Dominic P.; Razavi, Mehdi; Safirstein, Jordan; Mehran, Roxana; Kirtane, Ajay J.; Généreux, Philippe.

In: JAMA Cardiology, Vol. 2, No. 7, 07.2017, p. 798-802.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mortality, length of stay, and cost implications of procedural bleeding after percutaneous interventions using large-bore catheters

AU - Redfors, Björn

AU - Watson, Brendan M.

AU - McAndrew, Thomas

AU - Palisaitis, Emilie

AU - Francese, Dominic P.

AU - Razavi, Mehdi

AU - Safirstein, Jordan

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Généreux, Philippe

PY - 2017/7

Y1 - 2017/7

N2 - IMPORTANCE Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity. OBJECTIVE To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016. MAIN OUTCOMES AND MEASURES Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications. RESULTS Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95%CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95%CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95%CI, 1.52-1.59; P < .001). CONCLUSIONS AND RELEVANCE Periprocedural bleedingwas common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.

AB - IMPORTANCE Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity. OBJECTIVE To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016. MAIN OUTCOMES AND MEASURES Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications. RESULTS Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95%CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95%CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95%CI, 1.52-1.59; P < .001). CONCLUSIONS AND RELEVANCE Periprocedural bleedingwas common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.

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