TF-TAVI and SAVR post-procedural complications in Germany 2021/2022 – impact on healthcare resource consumption

Abstract

Background Post-procedural complications after transfemoral transcatheter aortic valve implantation (TF-TAVI) lead to extended healthcare resource consumption. A comparison with resource consumption after surgical aortic stenosis valve replacement (SAVR) complications has not been conducted. Methods The impact of acute kidney injury (AKI), stroke, severe bleeding and permanent pacemaker implantation (PPI) on length of stay, mechanical ventilation > 48 h and reimbursement was analyzed by risk-adjusted linear and logistic regression analyses of all German aortic stenosis TF-TAVI and SAVR cases 2021/2022. Results 48,565 TF-TAVI and 9,803 SAVR procedures for aortic stenosis treatment were performed in Germany 2021/2022. The length of stay for TF-TAVI was shorter (10.16 ± 7.19 vs. 13.91 ± 9.82 days, p < 0.001), the rate of mechanical ventilation > 48 h was lower after TF-TAVI (1.3% vs. 7.0%, p < 0.001) and reimbursement was higher for TF-TAVI (26,483 ± 4,487 vs. 20,538 ± 11,748 €, p < 0.001). Length of stay was increased by all investigated complications after TF-TAVI and SAVR (p < 0.001) with the highest increase after bleeding in TF-TAVI. Odds ratios for mechanical ventilation > 48 h were significantly increased for stroke, severe bleeding and AKI (p < 0.001) but not for PPI after both TF-TAVI and SAVR with the highest OR increase after bleeding in TF-TAVI. Reimbursement was significantly increased after TF-TAVI and SAVR by all investigated complications (p < 0.001) finding significantly higher increases after SAVR compared to TF-TAVI for all complications. The total hospital stay after stroke, AKI and PPM was longer for SAVR (p < 0.001), while severe bleeding led to longer total hospital stay after TF-TAVI (p < 0.001). Total reimbursement remained higher for TF-TAVI after all investigated complications (p < 0.001). Conclusion Healthcare resource consumption differs between TF-TAVI and SAVR for aortic stenosis treatment also after procedural complications. SAVR is associated with longer hospitalization and more mechanical ventilation, while TF-TAVI is associated with higher reimbursement in the German healthcare system. Complications lead to increased resource use for both procedures with higher extra reimbursement for SAVR and more extra hospital days for TF-TAVI after bleeding reversing the length of stay advantage.