Hospital Variation in Outcomes for Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries, 2011 to 2013

For each hospital that performed at least 1 TAVR during the study period, we calculated risk-standardized 30-day mortality (30-day risk standardized mortality rate [RSMR]), 1-year mortality (1-year RSMR), and 30-day all-cause readmission (30-day risk standardized readmission rate [RSRR]) using the Centers for Medicare & Medicaid Services risk-standardized method (2,3), which employs 2-level (patient and hospital) hierarchical logistic regression models that account for the clustering of patients within the same hospital as well as patient-specific information on age and sex and a number of comorbidities identified from secondary discharge diagnosis codes in the index hospitalization as well as principal or secondary diagnosis codes of all inpatient hospitalizations up to 1 year prior. Adjusting for patient characteristics, the odds of each adverse outcome for a patient treated at a hospital 1 SD above the national average relative to that of a patient treated at a hospital 1 SD below the national average was statistically significant (Figure 1). Since the Food and Drug Administration approval of TAVR in November 2011, there has been rapid expansion in the number of hospitals performing TAVR.