Incremental Cost and Length of Stay Associated With Complications of Transcatheter Aortic Valve Replacement.

Background: Transcatheter aortic valve replacement (TAVR) has become the leading form of aortic valve replacement, with nearly 100,000 annual procedures in the United States. However, the impact of complications on hospital costs is not well understood.

Objectives: The purpose of this study was to quantify the additional hospital resource use and costs associated with TAVR complications.

Methods: Medicare Provider Analysis and Review file from fiscal year 2020 identified 66,893 beneficiaries undergoing TAVR. International Classification of Diseases-10th-Clinical Modification diagnostic and procedure codes were used to identify complications and hospital costs were calculated using cost-to-charge ratios. Multivariable regression estimated the incremental cost and length of stay (LOS) associated with complications.

Results: In 2020, 31.1% of the 66,893 Medicare beneficiaries who underwent a TAVR experienced one or more complications. The mean cost of a TAVR hospitalization was $54,988 ± $26,744 and the mean LOS was 3.1 ± 4.5 days. Patients who experience any of the complications increased costs by $15,377 and incremental LOS by 2.8 days compared to those not experiencing complications. After adjustments for patient risk factors, the incremental cost of complications was $12,953. Surgical aortic valve replacement ($42,924), acute renal failure requiring dialysis ($34,606), and in-hospital mortality ($25,307) had the highest risk-adjusted costs. Complications accounted for $320 million in additional costs, representing 8.7% of the total hospital cost for Medicare TAVR patients.

Conclusions: In contemporary practice, approximately one in 3 Medicare TAVR patients experience serious complications, substantially increasing hospital resource use. Despite improvements in TAVR outcomes and efficiency, additional cost savings can be achieved through complication mitigation.