Gender differences in the discharge outcomes post-TMVR among us patients 65 years and above: a review of 4,678 patients from the national inpatient sample
Authors: Nriagu B , Evbayekha E , Emezu G , Okafor C , Balogun O , Idowu A , Nriagu V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Though the Transcatheter mitral valve repair (TMVR) procedure has been shown to be beneficial among patients with moderate to severe mitral regurgitation, the effect of sex on the discharge outcomes post-TMVR remains unclear.

Purpose
We evaluated the gender differences in the outcomes, including death, next-day discharge, and discharge disposition among patients who underwent TMVR in the United States National Inpatient Sample (NIS) Database. We hypothesized that there would be no difference in the outcome of TMVR by gender in this study population.

Methods
Using the United States NIS Database 2016 – 2019, we identified all patients aged ≥ 65 years with a first listed ICD-10 procedure code of 02UG3JZ corresponding to the TMVR procedure. We classified patients with length of stay (LOS) ≤ 1 day as next day discharge (NDD) and LOS &gt;1 day as non-NDD. Discharge disposition was classified as home/short-term facility, long term facility, or death. Home/short-term facility was defined as patients who were discharged to home, to a short-term hospital, against medical advice, alive with an unknown destination, to home health care, or transferred to court/law enforcement. Disposition was defined as long-term facility if patients were discharged to a skilled nursing facility or intermediate care facility, or another type of facility. Multivariable logistic regression was used to estimate the odds of death and non-NDD, comparing all male patients who had a TMVR to all female patients who underwent TMVR adjusting for age, race, sex, Charlson Co-morbidity Index (CCI) score, median household income, primary insurance, hospital region, teaching status of the hospital and hospital bed size.

Results
Our study included 4,678 patients (mean age ± SD = 80.4 ± 6.8) who had TMVR between 2016 to 2019. In our study population, 47.5% were females (mean age ± SD = 80.7 ± 6.7) and 52.5% (mean age ± SD = 80.0 ± 6.8) were males. The mean CCI score was lower in females compared to men (mean CCI score ± SD = 2.8 ± 1.9 vs. 3.2 ± 2.0; p&lt;0.0001). Of the seventy-four (74) patients that died, 42 (56.8%) were female and 32 (43.2%) were male (p=0.10). Males were more likely to be discharged to a home/short-term facility than females (53.8% vs. 46.2%; p&lt;0.0001), while females were more likely to be discharged to a long-term facility than males (57.3% vs. 42.7%; p&lt;0.0001). Males were more likely to be discharged within the next day than females (56.1% vs. 43.9%; p&lt;0.0001). Compared to males, females had a higher odds of death (odds ratio (OR), 1.71 [95% CI, 1.03-2.83]; p=0.04) post-TMVR. Females also had higher odds of non-NDD compared to their male counterparts (odds ratio (OR), 1.42 [95% CI, 1.25-1.60]; p&lt;0.0001) post-TMVR.

Conclusion
Among patients aged 65 years and above who had a TMVR procedure, females were more likely to be discharged to a long-term facility and had higher odds of death and non-next-day discharge than males.