Association of care fragmentation with financial and clinical outcomes of transcatheter aortic valve replacement in the US: A retrospective cohort study

Purpose: Care fragmentation (CF), defined as readmission to a non-index facility, has historically been linked with adverse clinical and financial outcomes for a variety of cardiac procedures. However, its impact on patients undergoing transcatheter aortic valve replacement (TAVR) remains understudied. Methods: This retrospective study investigated the prevalence and impact of CF on outcomes of patients undergoing TAVR. All adults (≥18 years) undergoing an isolated TAVR procedure, who were readmitted within 90 days, were tabulated using the Nationwide Readmissions Database from 2016 to 2021. A 90-day readmission window was chosen in accordance with prior literature on readmission. Patients treated at a non-index facility were categorized into the CF cohort. Multivariable logistic models were developed to characterize the association of care fragmentation status with perioperative complications and resource utilization; candidate variables were selected using elastic net regularization to minimize variable collinearity. Results: Of an estimated 55,891 patients who were readmitted within 90 days, 37.4% were treated at a non-index facility. While TAVR utilization more than doubled, both the readmission and care fragmentation rates fell during the study period. Following adjustment, CF status was associated with respiratory (AOR [Adjusted Odds Ratio] 1.20, 95% CI [Confidence Interval] 1.11–1.29, p