PLoS One. 2026 Jul 21;21(7):e0353361. doi: 10.1371/journal.pone.0353361. eCollection 2026.
ABSTRACT
PURPOSE: Care fragmentation (CF), defined as readmission to a non-index facility, has historically been linked with adverse clinical and financial outcomes for a variety of cardiac procedures. However, its impact on patients undergoing transcatheter aortic valve replacement (TAVR) remains understudied.
METHODS: This retrospective study investigated the prevalence and impact of CF on outcomes of patients undergoing TAVR. All adults (≥18 years) undergoing an isolated TAVR procedure, who were readmitted within 90 days, were tabulated using the Nationwide Readmissions Database from 2016 to 2021. A 90-day readmission window was chosen in accordance with prior literature on readmission. Patients treated at a non-index facility were categorized into the CF cohort. Multivariable logistic models were developed to characterize the association of care fragmentation status with perioperative complications and resource utilization; candidate variables were selected using elastic net regularization to minimize variable collinearity.
RESULTS: Of an estimated 55,891 patients who were readmitted within 90 days, 37.4% were treated at a non-index facility. While TAVR utilization more than doubled, both the readmission and care fragmentation rates fell during the study period. Following adjustment, CF status was associated with respiratory (AOR [Adjusted Odds Ratio] 1.20, 95% CI [Confidence Interval] 1.11-1.29, p < 0.001), gastrointestinal (AOR 1.21, 95% CI 1.05-1.38, p = 0.008), and infectious complications (AOR 1.17, 95% CI 1.10-1.25, p < 0.001) at readmission. Furthermore, CF was linked with greater risk of non-home discharge (AOR: 1.13 95% CI [1.03-1.25], P = 0.01).
CONCLUSIONS: As TAVR utilization continues to expand nationwide, further efforts to enhance care coordination and streamline information sharing are warranted to mitigate the burden of care fragmentation.
PMID:42479695 | DOI:10.1371/journal.pone.0353361