Failure to Rescue, Hospital Volume, and In-Hospital Mortality After Transcatheter Aortic Valve Implantation

Failure to rescue (FTR), death after major complications, has been well described in the surgical literature as a source of different outcomes in different hospitals. However, FTR has not been investigated in transcatheter aortic valve implantation (TAVI). Our aim was to assess the difference of in-patient mortality and FTR in different TAVI volume hospitals. We queried the Nationwide Inpatient Sample database from 2011 to 2015 to identify patients who had transarterial TAVI. FTR was calculated as those who had in-patient mortality with at least one with major perioperative complications. Hospitals were divided into three groups according to annual TAVI volume, the lowest quintile (≤30/year), second to fourth quintile (31 to 130/year), and highest quintile (≥130/year). Multivariate analysis was used to calculate risk adjusted in-patient mortality rate and FTR and was compared between these different volume hospitals. A total of 48,886 TAVI procedures were identified (10,407, 28,811, and 9,668 in low, intermediate, and high volume centers, respectively). Mean age, percentage of woman, and Elixhauser co-morbidity index was similar across different TAVI volume hospital. The incidence of major perioperative complications did not differ in different volume hospitals. Adjusted rate of in-patient mortality (2.3%, 1.87%, and 1.57% for low, intermediate, and high volume center, respectively, p <0.001) were significantly less with greater hospital volume but FTR (8.24%, 8.20%, and 6.12% for low, intermediate, and high volume center, respectively, p = 0.29) were the same in the three groups. Our results suggest that FTR does not explain the variation of in-hospital mortality in different hospital volumes.