Factors associated with total cost in SAVR, SAVR with CABG and TAVI
| Isolated SAVR | SAVR with CABG | TAVI | ||||
|---|---|---|---|---|---|---|
| RR (95% CI) | p Value | RR (95% CI) | p Value | RR (95% CI) | p Value | |
| Patient-level factors | ||||||
| Demographics | ||||||
| Age | ||||||
| 20–74 | Referent | |||||
| 75+ | 1.12 (1.05 to 1.19) | 0.0007 | 1.04 (0.97 to 1.12) | 0.3015 | 1.13 (1.01 to 1.26) | 0.0295 |
| Male | Referent | |||||
| Female | 1.01 (0.95 to 1.07) | 0.7772 | 1.04 (0.96 to 1.13) | 0.3139 | 1.06 (0.97 to 1.16) | 0.2298 |
| Medical comorbidities | ||||||
| COPD | 1.13 (1.00 to 1.28) | 0.0515 | 1.10 (0.97 to 1.24) | 0.1332 | 1.26 (1.12 to 1.40) | 0.0001 |
| CVD | 1.21 (1.09 to 1.35) | 0.0006 | 1.01 (0.90 to 1.13) | 0.8652 | 1.04 (0.94 to 1.15) | 0.4138 |
| PVD | 1.04 (0.91 to 1.18) | 0.5960 | 1.05 (0.96 to 1.16) | 0.2876 | 0.97 (0.88 to 1.07) | 0.5304 |
| BMI* | ||||||
| Underweight/normal | Referent | |||||
| Overweight | 1.00 (0.93 to 1.07) | 0.9645 | 1.07 (0.97 to 1.17) | 0.1604 | 0.93 (0.85 to 1.02) | 0.1291 |
| Missing | 0.99 (0.87 to 1.13) | 0.9130 | 1.06 (0.88 to 1.28) | 0.5572 | 0.95 (0.79 to 1.14) | 0.5678 |
| Renal function | ||||||
| Creatinine 0–140 μmol/L | Referent | |||||
| Creatinine >140 μmol/L | 1.13 (1.01 to 1.26) | 0.0371 | 1.08 (0.94 to 1.23) | 0.2616 | 1.00 (0.90 to 1.12) | 0.9813 |
| Missing | 0.99 (0.88 to 1.11) | 0.8393 | 0.92 (0.76 to 1.12) | 0.4126 | 1.05 (0.91 to 1.21) | 0.5361 |
| Dialysis | 1.35 (1.02 to 1.78) | 0.0347 | 0.90 (0.72 to 1.13) | 0.3565 | 1.19 (0.86 to 1.66) | 0.2855 |
| Anticoagulant use | 1.01 (0.92 to 1.11) | 0.8365 | 1.00 (0.90 to 1.12) | 0.9422 | 1.01 (0.92 to 1.10) | 0.8295 |
| Cardiac risk factors | ||||||
| Diabetes | 1.09 (1.02 to 1.17) | 0.0157 | 0.98 (0.91 to 1.06) | 0.6466 | 1.01 (0.93 to 1.10) | 0.7275 |
| Hypertension | 1.00 (0.94 to 1.07) | 0.9826 | 1.04 (0.95 to 1.13) | 0.4144 | 1.03 (0.92 to 1.17) | 0.5974 |
| Hyperlipidaemia | 1.00 (0.94 to 1.07) | 0.9042 | 1.05 (0.96 to 1.14) | 0.2696 | 0.96 (0.87 to 1.06) | 0.3841 |
| Smoking | ||||||
| Never/missing/unknown | Referent | |||||
| Former/current smoker | 0.95 (0.89 to 1.01) | 0.0733 | 0.97 (0.90 to 1.04) | 0.3670 | 1.00 (0.92 to 1.09) | 0.9593 |
| Active endocarditis | 1.31 (1.09 to 1.56) | 0.0033 | 1.09 (0.49 to 2.40) | 0.8332 | NA | |
| Cardiac history | ||||||
| History of MI† | 1.08 (0.93 to 1.24) | 0.3303 | 1.06 (0.95 to 1.17) | 0.2962 | 1.02 (0.93 to 1.13) | 0.6109 |
| Recent MI‡ | 0.81 (0.69 to 0.94) | 0.0054 | 1.16 (1.03 to 1.30) | 0.0126 | 1.24 (0.99 to 1.56) | 0.0633 |
| Previous PCI | 0.93 (0.79 to 1.10) | 0.4010 | 1.09 (0.97 to 1.23) | 0.1634 | 1.00 (0.91 to 1.09) | 0.9574 |
| Previous CABG | 1.03 (0.87 to 1.22) | 0.7336 | 0.95 (0.79 to 1.14) | 0.5784 | 1.09 (0.99 to 1.20) | 0.0938 |
| CHF | 1.05 (0.97 to 1.14) | 0.1971 | 1.28 (1.16 to 1.41) | <0.0001 | 0.97 (0.88 to 1.06) | 0.4490 |
| LVEF | ||||||
| ≥35% | Referent | |||||
| <34% | 1.03 (0.90 to 1.16) | 0.6973 | 0.95 (0.83 to 1.08) | 0.4247 | 1.07 (0.93 to 1.23) | 0.3282 |
| Unknown | 0.89 (0.79 to 0.99) | 0.0374 | 1.04 (0.88 to 1.23) | 0.6591 | 0.98 (0.76 to 1.26) | 0.8787 |
| Procedural factors | ||||||
| AV repair | 1.26 (0.94 to 1.69) | 0.1179 | 0.90 (0.65 to 1.24) | 0.5074 | NA | |
| Other procedures§ | 1.14 (1.02 to 1.28) | 0.0260 | 1.09 (0.96 to 1.25) | 0.239 | NA | |
| Transfemoral approach | ||||||
| Yes | Referent | |||||
| No | NA | NA | 1.31 (1.18 to 1.45) | <0.0001 | ||
| Wait location | ||||||
| Outpatient | Referent | |||||
| Inpatient¶ | 1.41 (1.20 to 1.66) | <0.0001 | 1.02 (0.87 to 1.21) | 0.7914 | 0.87 (0.60 to 1.27) | 0.4768 |
| IP wait length | ||||||
| IP ≤4 days | Referent | |||||
| IP ≥5 days | 0.94 (0.79 to 1.12) | 0.4842 | 1.02 (0.87 to 1.21) | 0.7768 | 1.44 (0.95 to 2.17) | 0.0814 |
| Short length of stay** | ||||||
| Yes | Referent | |||||
| No | 1.28 (0.86 to 1.92) | 0.2276 | 1.29 (0.87 to 1.92) | 0.2068 | 1.42 (1.14 to 1.78) | 0.0023 |
| Long ICU length of stay†† | ||||||
| No | Referent | |||||
| Yes | 2.16 (1.99 to 2.35) | <0.0001 | 2.05 (1.89 to 2.21) | <0.0001 | 1.30 (1.20 to 1.41) | <0.0001 |
Bold values are statistically significant.
*BMI: underweight=<18.5, normal=18.5–24.9, overweight=25–29.9, obese=≥30.
†History of MI: MI >30 days ago.
‡Recent MI: MI within the past 30 days.
§Other procedures: aneurysectomy, myectomy, atrial septal defect closure, ventricular septal defect closure, aortic surgery pericardectomy, arrhythmia surgery, cardiac tumour surgery, other surgery.
¶Wait location—inpatient=if wait location at referral, acceptance or booking is a hospital or EMS Direct.
**Short length of stay: ≤2 days.
††Long ICU length of Stay: ≥4 days.
AV, aortic valve; BMI, body mass index; CABG, coronary artery bypass grafting; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CVD, cerebrovascular disease; ICU, intensive care unit; IP, inpatient; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NA, not applicable; PCI, percutaneous coronary intervention; PVD, peripheral vascular disease; RR, rate ratio; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.