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Study Examines Validity of 30-day vs 90-day Mortality as Hospital Performance Metric for TAVR and SAVR

A study published in JAMA Cardiology sought to examine the validity of 30-day vs 90-day mortality as a hospital performance metric for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

The study analyzed data from Medicare beneficiaries undergoing TAVR and SAVR procedures from January 1, 2012, to December 31, 2015. Hospitals were ranked into top- (10%), middle- (80%), and bottom-performing (10%) groups based on their 4-year mean 30-day mortality.

This study of Medicare beneficiaries found that evaluation of hospital performance based on 30-day mortality may underestimate outcomes and therefore substantially misrepresent institutional performance after TAVR and SAVR compared with 90-day mortality, even after risk adjustment. Capturing 90-day events was also more robustly informative regarding expected 1-year outcomes.

The findings suggest that evaluation of hospital performance based on 30-day mortality may underestimate outcomes and therefore substantially misrepresent institutional performance after TAVR and SAVR compared with 90-day mortality, even after risk adjustment. Although 30-day mortality has been validated, 90-day mortality may be a more reliable outcome metric for measuring hospital performance and capturing procedure-related mortality.

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