In-Hospital Outcomes After Tricuspid Valve Surgery in the United States

BACKGROUND: The impact of institutional experience on postoperative outcomes among patients undergoing isolated or concomitant tricuspid valve operations is not well studied. OBJECTIVES: The authors characterized the presence of a potential volume-outcome relationship between center-level cardiac valve procedural volume and risks of in-hospital mortality as well as resource utilization in a national cohort. METHODS: The 2016 to 2022 Nationwide Readmissions Database was reviewed to identify all adults undergoing isolated or concomitant tricuspid valve replacement or repair. A multivariable regression model was developed to evaluate mortality and hospitalization costs. Hospitals were categorized as high (HVH) or low volume based on explanatory analysis. The association of HVH status with postoperative complications, length of stay, and 30-day nonelective readmission were subsequently examined. RESULTS: Of an estimated 35,567 patients, 21,723 (61.0%) were treated at HVH. Compared to low-volume hospital, HVH patients were older, less commonly females, and more commonly of the highest income quartile. Patients at HVH more frequently received an isolated operation (21.0 vs 20.2%; P = 0.01). Following risk-adjustment, treatment at an HVH was associated with lower odds of mortality (adjusted OR: 0.56; 95% CI: 0.47-0.68) and cardiac complications (adjusted OR: 0.83; 95% CI: 0.73-0.94). However, HVH status was associated with increased costs by $6,070, but lower odds of nonhome discharge and 30-day nonelective readmission. CONCLUSIONS: HVH status was associated with lower odds of in-hospital mortality and reduced risk of 30-day nonelective readmission, but greater hospitalization costs. Increased outreach and resource availability at low-volume centers may help alleviate this disparity and enhance the overall value of care in tricuspid valve surgery.