Medical Research: What is the background for this study? What are the main findings?
Response: Aortic valve disease is common among older people and frequently requires valve replacement. 1-year survival after open surgical aortic valve replacement is high (9 in 10 survive the year after surgery). Our study focuses on the experience of these survivors in terms of the need for hospitalization during the year after surgery.
Among patients >65 years of age enrolled in Medicare who underwent surgical replacement of their aortic valve and survived at least one year, 3 in 5 were free from hospitalization during that year. Both, the rates of hospitalization and the average total number of days spent in the hospital in the year following surgery have been decreasing all through the last decade (1999 to 2010).
Medical Research: What should clinicians and patients take away from your report?
Response: Surgical valve replacement is becoming safer over time. Our previous study showed that over the last decade 1-year survival after aortic valve replacement increased from 86% to 89%. Our present study shows that the majority of these survivors are free from hospitalization and the need to be hospitalized is continually decreasing (from 44% to 41%).
These days, newer techniques of valve replacement not requiring open surgery have emerged. Some studies show them to be comparable in mortality outcomes. However, there is no comparable data for the need for hospitalization, which is equally important to patients. Further, our previous study showing declining mortality and the present one showing the decreasing need for hospitalization indicate that these newer procedures are pitted against a continually improving target.
There are certain sub-groups of patients like patients older than 85, female or black patients and those undergoing bypass surgery at the same time, who have higher rates of re-hospitalization. Focusing on these high risk sub-groups may further reduce rates of readmission following AVR. In addition, among those hospitalized almost half were hospitalized within 30 days, indicating the need to monitor patients closely during this period of heightened risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: As a large proportion of the hospitalized patients were hospitalized within the first 30 days it indicates the potential to improve post op care, discharge practices and transition in care. However, in order to develop targeted interventions, further research is needed to illuminate the underlying reasons for hospitalization during this period in this particular population of patients.
Trends in Hospitalizations Among Medicare Survivors of Aortic Valve Replacement in the United States From 1999 to 2010
Karthik Murugiah, MD , Yun Wang, PhD, John A. Dodson, MD, Sudhakar V. Nuti, BA, Kumar Dharmarajan, MD, MBAa, b, Isuru Ranasinghe, MBChB, PhDa, Zack Cooper, PhD, Harlan M. Krumholz, MD, SM
The Annals of Thoracic Surgery
Available online 16 December 2014