Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach
Background: For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing T...
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| Veröffentlicht in: | Gerontology (Basel) 2022-07, Vol.68 (7), p.746-754 |
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| creator | Bobet, Anne Sophie Brouessard, Céline Le Tourneau, Thierry Manigold, Thibaut de Decker, Laure Boureau, Anne-Sophie |
| description | Background: For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. Methods: This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. Results: median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (p value = 0.02), prior major neurocognitive disorders (p value = 0.01), femoral access (p value |
| doi_str_mv | 10.1159/000518821 |
| format | Article |
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The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. Methods: This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. Results: median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (p value = 0.02), prior major neurocognitive disorders (p value = 0.01), femoral access (p value <0.001), all complications (p value <0.001), and discharge in a rehabilitation center (p value <0.001). One-fourth (27%) of the patients had at least 1 geriatric complication. After CGA, 69 patients did not need any geriatric recommendation, whereas for the 127 other patients, an individualized-care plan was established but only 46 (36%) of them were followed up. Conclusion: Our results favor the preoperative screening for major neurocognitive disorders in order to reduce LOS. Furthermore, the proposed individual-care plans after CGA were poorly followed. Practitioners may perceive the preoperative CGA as a screening tool, but its primary objective is to develop an individualized-care plan as a prehabilitation plan in order to optimize the physical, functional, and social issues.</description><identifier>ISSN: 0304-324X</identifier><identifier>EISSN: 1423-0003</identifier><identifier>DOI: 10.1159/000518821</identifier><identifier>PMID: 34903687</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Aged patients ; Aortic valve stenosis ; Care and treatment ; Clinical Section: Research Article ; Diagnosis ; Geriatric assessment ; Heart valve replacement ; Hospital utilization ; Length of stay ; Methods ; Patient outcomes ; Risk factors</subject><ispartof>Gerontology (Basel), 2022-07, Vol.68 (7), p.746-754</ispartof><rights>2021 S. Karger AG, Basel</rights><rights>COPYRIGHT 2022 S. Karger AG</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-26e9dc4646532bef507e05f5d336803652f51c078953e9eaf63042e6786b0f023</citedby><cites>FETCH-LOGICAL-c409t-26e9dc4646532bef507e05f5d336803652f51c078953e9eaf63042e6786b0f023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,2425,27907,27908</link.rule.ids></links><search><creatorcontrib>Bobet, Anne Sophie</creatorcontrib><creatorcontrib>Brouessard, Céline</creatorcontrib><creatorcontrib>Le Tourneau, Thierry</creatorcontrib><creatorcontrib>Manigold, Thibaut</creatorcontrib><creatorcontrib>de Decker, Laure</creatorcontrib><creatorcontrib>Boureau, Anne-Sophie</creatorcontrib><title>Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach</title><title>Gerontology (Basel)</title><addtitle>Gerontology</addtitle><description>Background: For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. Methods: This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. Results: median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (p value = 0.02), prior major neurocognitive disorders (p value = 0.01), femoral access (p value <0.001), all complications (p value <0.001), and discharge in a rehabilitation center (p value <0.001). One-fourth (27%) of the patients had at least 1 geriatric complication. After CGA, 69 patients did not need any geriatric recommendation, whereas for the 127 other patients, an individualized-care plan was established but only 46 (36%) of them were followed up. Conclusion: Our results favor the preoperative screening for major neurocognitive disorders in order to reduce LOS. Furthermore, the proposed individual-care plans after CGA were poorly followed. Practitioners may perceive the preoperative CGA as a screening tool, but its primary objective is to develop an individualized-care plan as a prehabilitation plan in order to optimize the physical, functional, and social issues.</description><subject>Aged patients</subject><subject>Aortic valve stenosis</subject><subject>Care and treatment</subject><subject>Clinical Section: Research Article</subject><subject>Diagnosis</subject><subject>Geriatric assessment</subject><subject>Heart valve replacement</subject><subject>Hospital utilization</subject><subject>Length of stay</subject><subject>Methods</subject><subject>Patient outcomes</subject><subject>Risk factors</subject><issn>0304-324X</issn><issn>1423-0003</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNptkc9rFDEUx4Modq0evHsIFEQPU1-S-dnbUtpVWKjUVrwNaeZlJjqbTJOs0P--GUYWCyWHkO_7fL_vhUfIewanjBXNFwAoWF1z9oKsWM5FlgTxkqxAQJ4Jnv86Im9C-J1E4AxekyORNyDKulqR-y3aPg7UafojygdqLL0aO_T0u4wGbQz01qZn74zt6Y2XNigZB4yJWDsfjaI_5fgX6TVOo1S4S5azWdrjHCnpBr2R0SduPU3eSTW8Ja-0HAO--3cfk9vLi5vzr9n2avPtfL3NVA5NzHiJTafyMi8Lwe9QF1AhFLroRBo8DV9wXTAFVd0UAhuUukyf5VhWdXkHGrg4Jp-W3NT2fo8htjsTFI6jtOj2oeUlA6gaUbOEnixoL0dsjdUueqlmvF1X0DTAoZgDT5-h0ulwZ5SzqE3Snxg-_mcYUI5xCG7cR-NseAp-XkDlXQgedTt5s5P-oWXQzhtuDxtO7IeF_SN9j_5AHsonz5Y3F9cL0U6dFo8a56fD</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Bobet, Anne Sophie</creator><creator>Brouessard, Céline</creator><creator>Le Tourneau, Thierry</creator><creator>Manigold, Thibaut</creator><creator>de Decker, Laure</creator><creator>Boureau, Anne-Sophie</creator><general>S. Karger AG</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20220701</creationdate><title>Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach</title><author>Bobet, Anne Sophie ; Brouessard, Céline ; Le Tourneau, Thierry ; Manigold, Thibaut ; de Decker, Laure ; Boureau, Anne-Sophie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-26e9dc4646532bef507e05f5d336803652f51c078953e9eaf63042e6786b0f023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged patients</topic><topic>Aortic valve stenosis</topic><topic>Care and treatment</topic><topic>Clinical Section: Research Article</topic><topic>Diagnosis</topic><topic>Geriatric assessment</topic><topic>Heart valve replacement</topic><topic>Hospital utilization</topic><topic>Length of stay</topic><topic>Methods</topic><topic>Patient outcomes</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bobet, Anne Sophie</creatorcontrib><creatorcontrib>Brouessard, Céline</creatorcontrib><creatorcontrib>Le Tourneau, Thierry</creatorcontrib><creatorcontrib>Manigold, Thibaut</creatorcontrib><creatorcontrib>de Decker, Laure</creatorcontrib><creatorcontrib>Boureau, Anne-Sophie</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gerontology (Basel)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bobet, Anne Sophie</au><au>Brouessard, Céline</au><au>Le Tourneau, Thierry</au><au>Manigold, Thibaut</au><au>de Decker, Laure</au><au>Boureau, Anne-Sophie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach</atitle><jtitle>Gerontology (Basel)</jtitle><addtitle>Gerontology</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>68</volume><issue>7</issue><spage>746</spage><epage>754</epage><pages>746-754</pages><issn>0304-324X</issn><eissn>1423-0003</eissn><abstract>Background: For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. Methods: This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. Results: median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (p value = 0.02), prior major neurocognitive disorders (p value = 0.01), femoral access (p value <0.001), all complications (p value <0.001), and discharge in a rehabilitation center (p value <0.001). One-fourth (27%) of the patients had at least 1 geriatric complication. After CGA, 69 patients did not need any geriatric recommendation, whereas for the 127 other patients, an individualized-care plan was established but only 46 (36%) of them were followed up. Conclusion: Our results favor the preoperative screening for major neurocognitive disorders in order to reduce LOS. Furthermore, the proposed individual-care plans after CGA were poorly followed. Practitioners may perceive the preoperative CGA as a screening tool, but its primary objective is to develop an individualized-care plan as a prehabilitation plan in order to optimize the physical, functional, and social issues.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>34903687</pmid><doi>10.1159/000518821</doi><tpages>9</tpages></addata></record> |
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| source | Karger Journals; Alma/SFX Local Collection |
| subjects | Aged patients Aortic valve stenosis Care and treatment Clinical Section: Research Article Diagnosis Geriatric assessment Heart valve replacement Hospital utilization Length of stay Methods Patient outcomes Risk factors |
| title | Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach |
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