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Mortality, Length of Stay, and Cost Implications of Procedural Bleeding After Percutaneous Interventions Using
Björn Redfors1, Brendan M Watson2, Thomas McAndrew3
1Cardiovascular Research Foundation, New York, New York2Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Bleeding complications are common after large-bore catheter interventions, significantly increasing mortality and hospital costs. These findings highlight the need for strategies to mitigate bleeding risks in such procedures.
Area of Science:
- Cardiology
- Vascular Surgery
- Health Services Research
Background:
- Percutaneous transcatheter interventions utilizing large-bore catheters are increasingly common.
- Bleeding complications following these procedures are a significant concern, linked to adverse outcomes.
Purpose of the Study:
- To determine the incidence of bleeding complications in patients undergoing contemporary endovascular interventions with large-bore catheters.
- To analyze the association between these bleeding complications and in-hospital mortality, length of hospital stay, and healthcare costs.
Main Methods:
- A retrospective cohort study using the National Inpatient Sample database (2012-2013).
- Included patients undergoing transcatheter aortic valve replacement, endovascular aneurysm repair, or percutaneous left ventricular assist device implantation.
- Bleeding complications defined by transfusion, hemorrhage, hematoma, or need for intervention; costs calculated from hospital charges.
Main Results:
- Bleeding complications occurred in 17.7% of 17,672 patients.
- Bleeding was associated with a 2.7-fold increase in mortality (aOR, 2.70) and a 2.14-fold increase in hospital stay.
- Median healthcare costs were significantly higher for patients with bleeding complications ($48,663 vs. $29,968).
Conclusions:
- Periprocedural bleeding is frequent in transcatheter interventions using large-bore catheters.
- Such bleeding significantly increases mortality, length of stay, and healthcare costs.
- These findings underscore the clinical and economic burden of bleeding complications in this patient population.
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 bleeding was 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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