Incidence and Causes of In-hospital Outcomes and 30-day Readmissions After Percutaneous Left Atrial Appendage Closure: A United States Nationwide Retrospective Cohort Study Using Claims Data.
Heart Rhythm. 2019 Sep 17;:
Authors: Vuddanda VLK, Turagam MK, Umale NA, Shah Z, Lakkireddy DR, Bartus K, McCausland FR, Velagapudi P, Mansour M, Heist EK
BACKGROUND: Percutaneous left atrial appendage closure (p-LAAC) emerged as an option for stroke prevention in atrial fibrillation (AF) patients’ ineligible for long-term anticoagulation.Real-world data on its in-hospital and 30-day readmission measures are limited.
OBJECTIVE: We sought to report the nationwide incidence of the above outcomes using 2016 claims data.
METHODS: We used the National Inpatient Sample for In-hospital outcomes and Nationwide Readmissions Data for readmissions. We identified hospitalizations with a primary diagnosis of AF and p-LAAC procedure, using International Classification of Diseases, Tenth Revision, codes and compared the outcomes mentioned above between the endocardial and epicardial cohorts. Statistical analyses were performed using R 3.3.2 RESULTS: Among 5480 p-LAACs (endocardial: 5145, epicardial: 335) the in-hospital mortality was 0.3%. Endocardial LAAC had lower complications (8.5% vs 25.4%; p < 0.001), length of stay (1 [1,1] vs 2 [1,3] day(s) p < 0.001) but higher hospitalization cost (24.13 [18.45, 30.17] vs 21.21 [14.03, 27.86] X1,000 dollars; p = 0.016). The most common complications include pericardial (endo vs epi: 3% vs 10.4% p <0.001), and renal failure (1.4% vs 6.0% p 0.004)). Epicardial LAAC had higher 30-day unplanned readmissions (19.5% vs 8.3% p 0.001) with the most common reason being pericarditis + effusion (33.9%).
CONCLUSION: Endocardial LAAC had lower complications and 30-day readmissions but higher hospitalization cost. Though epicardial LAAC showed higher complications, given recent improvements in its technique, and postprocedural care demonstrated a significant reduction in pericardial complications, more contemporary data comparing these outcomes are needed.
PMID: 31539630 [PubMed – as supplied by publisher]