Impact of Malnutrition on Outcomes Following Transcatheter Aortic Valve Implantation (from a National Cohort)
| Autor: | Sarah E. Rudasill, Sara Emami, Josef Madrigal, Nathaniel Christian-Miller, Peyman Benharash, Yas Sanaiha, Mario Cale, Nikhil Bellamkonda |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Time Factors 030204 cardiovascular system & hematology Cachexia Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Postoperative Complications Weight loss Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Hospital Mortality Registries Propensity Score Retrospective Studies Aged 80 and over business.industry Incidence Malnutrition Retrospective cohort study Aortic Valve Stenosis Length of Stay medicine.disease United States Cardiac surgery Survival Rate Stenosis Aortic Valve Cohort Cardiology Female Underweight medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The American journal of cardiology. 125(7) |
| ISSN: | 1879-1913 |
| Popis: | Malnutrition is associated with increased mortality in open cardiac surgery, but its impact on transcatheter aortic valve implantation (TAVI) is unknown. This study utilized the National Readmissions Database to evaluate the impact of malnutrition on mortality, complications, length of stay (LOS), 30-day readmission, and total charges following TAVI. Adult patients undergoing isolated TAVI for severe aortic stenosis were identified using the 2011 to 2016 National Readmissions Database, which accounts for 56.6% of all US hospitalizations. The malnourished cohort included patients with nutritional neglect, cachexia, protein calorie malnutrition, postsurgical nonabsorption, weight loss, and underweight status. Multivariable models were utilized to evaluate the impact of malnutrition on selected outcomes. Of 105,603 patients, 5,280 (5%) were malnourished. Malnourished patients experienced greater mortality (10.4% vs 2.2%, p0.001), postoperative complications (49.2% vs 22.6%, p0.001), 30-day readmission rates (21.4 vs 14.9%, p0.001), index hospitalization charges ($331,637 vs $208,082, p0.001), and LOS (16.4 vs 6.2 days, p0.001) relative to their nourished counterparts. On multivariable analysis, malnutrition remained a significant, independent predictor of increased index mortality (Adjusted odds ratio (AOR) = 2.68, p0.001), complications (AOR = 2.09, p0.001), and 30-day readmission rates (AOR = 1.34, p0.001). Malnutrition was most significantly associated with infectious complications at index hospitalization (AOR = 3.88, p0.001) and at 30-day readmission (AOR = 1.43, p0.027). In conclusion, malnutrition is independently associated with increased mortality, complications, readmission, and resource utilization in patients undergoing TAVI. Preoperative risk stratification and malnutrition modification may improve outcomes in this vulnerable population. |
| Databáze: | OpenAIRE |
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