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%, p <0.001), postoperative
complications (49.2% vs 22.6%, p <0.001), 30-day readmission rates (21.4 vs 14.9%,
p <0.001), index hospitalization charges ($331,637 vs $208,082, p <0.001), and LOS
(16.4 vs 6.2 days, p <0.001) relative to their nourished counterparts. On multivariable
analysis, malnutrition remained a significant, independent predictor of increased
index mortality (Adjusted odds ratio (AOR) = 2.68, p <0.001), complications (AOR = 2.09,
p <0.001), and 30-day readmission rates (AOR = 1.34, p <0.001). Malnutrition was most
significantly associated with infectious complications at index hospitalization (AOR = 3.88,
p <0.001) and at 30-day readmission (AOR = 1.43, p <0.027). 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.
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Article info
Publication history
Published online: January 07, 2020
Received in revised form:
December 17,
2019
Received:
October 29,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
