Introduction Of Transcatheter Aortic Valve Replacement Technology Increases Overall Aortic Valve Surgical Volume: A Novel Technique For Evaluating The Florida Experience
*Michael P Rogers1, *Haroon Janjua1, *Emanuel Eguia2, *Lucian Lozonschi3, Paul C Kuo1
1Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL;2Loyola University Medical Center, Maywood, IL;3Division of Cardiothoracic Surgery and Transplantation, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
OBJECTIVE(S): Transcatheter aortic valve replacement (TAVR) technology is increasingly utilized for aortic valve stenosis. As indications continue to expand, we sought to evaluate the adoption of TAVR technology with respect to overall surgical aortic valve replacement (SAVR) volume utilizing a Difference in Difference (DID) technique. METHODS: The 2010-2019 Florida Agency for Health Care Administration Inpatient data was queried for SAVR and TAVR. DID analysis based on Poisson regression was used to evaluate the impact of TAVR on the total aortic valve surgical volume of TAVR versus non-TAVR performing hospitals. Incident Rate Ratios (IRR) from DID analysis determined the significance of TAVR technology. For each technique in each procedure, length of stay (LOS) and elements of charges were compared for the raw and 1:1 propensity matched data to determine statistical significance. RESULTS: A total of 46,032 overall surgical aortic valve procedures were performed at 88 hospitals, 70 of which had TAVR performing capabilities. TAVR performing hospitals experienced a 20% increase in total aortic valve surgical volume due to introduction and use of TAVR technology (IRR 1.20, p value <0.001) (Table 1). Length of stay was significantly less for patients undergoing TAVR for overall (7.4 vs 10.7 days, p<0.001) and propensity matched (7.4 vs 11.4 days, p<0.001) cohorts. Propensity matched TAVR patients had less gross total charges ($263,841 vs $272,024, p<0.001), though this difference was not significant for the overall cohorts. While overall medical and surgical supply charges were significantly more for TAVR vs SAVR ($122,213 vs $51,232, p<0.001), other charges including room and board were less overall. CONCLUSIONS: Introduction of TAVR technology significantly increased the overall surgical aortic valve volume and may be associated with less total hospital charges. As TAVR technology continues to improve and with the wide adoption of the minimalist approach, we expect further reduction in overall patient cost.
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