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dc.contributor.authorvuddanda, Venkat lakshmi kishan
dc.date.accessioned2019-12-17T10:05:25Z
dash.embargo.terms2021-05-01
dc.date.created2019-05
dc.date.issued2019-05-30
dc.date.submitted2019
dc.identifier.citationvuddanda, Venkat lakshmi kishan. 2019. 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. Master's thesis, Harvard Medical School.
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:42061459*
dc.description.abstractBackground: 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.
dc.description.sponsorshipMaster’s Program in Clinical Investigation
dc.format.mimetypeapplication/pdf
dc.language.isoen
dash.licenseLAA
dc.subjectpercutaneous left atrial appendage closure
dc.subjectPrediction models
dc.subjectNIS
dc.subjectNRD
dc.subjectClaims data
dc.titlePercutaneous Left Atrial Appendage Closure: Incidence, Causes and Predictors of In-Hospital Outcomes and Readmissions a United States Nationwide Retrospective Cohort Study Using Claims Data
dc.typeThesis or Dissertation
dash.depositing.authorvuddanda, Venkat lakshmi kishan
dash.embargo.until2021-05-01
dc.date.available2019-12-17T10:05:25Z
thesis.degree.date2019
thesis.degree.grantorHarvard Medical School
thesis.degree.grantorHarvard Medical School
thesis.degree.levelMasters
thesis.degree.levelMasters
thesis.degree.nameMaster of Medical Sciences
thesis.degree.nameMaster of Medical Sciences
dc.contributor.committeeMemberSingh, Ajay K.
dc.contributor.committeeMemberHeist, Kevin E.
dc.contributor.committeeMemberParikh, Valay
dc.contributor.committeeMemberMcCausland, Finnian R.
dc.contributor.committeeMemberMadden, Kate
dc.type.materialtext
dash.identifier.vireo
dc.identifier.orcid0000-0002-4804-6740
dash.author.emailkishanvuddanda@gmail.com


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