Percutaneous Left Atrial Appendage Closure: Incidence, Causes and Predictors of In-Hospital Outcomes and Readmissions a United States Nationwide Retrospective Cohort Study Using Claims Data

Abstract

Background: Percutaneous Left atrial appendage closure (p-LAAC) emerged as a suitable option for stroke prevention in patients with atrial fibrillation (AF) considered ineligible for long-term oral anticoagulation. Data on in-hospital outcomes and 30-day readmissions after p-LAAC predominantly comes from either clinical trials or small institutions that do not fully estimate the nationwide incidence of these outcomes. Methods: We used 2016 National Inpatient Sample for In-hospital outcomes and Nationwide Readmissions Data, for 30-day readmissions. Each dataset included diagnosis and procedure codes reported using the International Classification of Diseases, Tenth Revision, Clinical Modification / Procedure Coding System (ICD-10 CM/PCS). Adults (age > 18 yrs.), with a primary diagnosis of AF who had p-LAAC were identified using ICD-10 codes. We report the in-hospital (complications, length of stay, and cost) and 30-day unplanned readmission outcomes in patients who underwent p-LAAC. All statistical analyses were performed using R 3.3.2 and “survey” package was used to set up survey design and obtain national estimates. Results: 5480 p-LAAC procedures (endocardial: 5145, epicardial: 335) which were performed in the United states in 2016 were available for this analysis. In-hospital mortality rate was 0.3% with no difference between endocardial and epicardial LAAC. Overall in-hospital complication rate was 9.5% (endocardial 8.5%, epicardial 25.4%, p<0.001). Endocardial LAAC performed at high volume centers (> 50/year) had lower complications (5.5%) than lower volume centers. The most common complications were pericardial (endo vs epi-LAAC: 3% vs 10.4% p <0.001), bleeding (2.3% vs 6%; p 0.069), and renal failure (1.4% vs 6.0% p 0.004)). 30-day unplanned all-cause readmission rates after endocardial and epicardial LAAC were 8.3% and 19.5% with the most common causes being gastrointestinal bleeding (16.16%), and pericarditis with or without pericardial effusion (33.9%) respectively.