Supplementary table: Regional differences in the utilization and outcomes of cerebral embolic protection during transcatheter aortic valve replacement: an analysis of the National Inpatient Sample from 2017 through 2019

These are peer-reviewed supplementary materials for the article 'Regional differences in the utilization and outcomes of cerebral embolic protection during transcatheter aortic valve replacement: an analysis of the National Inpatient Sample from 2017 through 2019' published in the Journal of Comparative Effectiveness Research.Appendix Table 1: ICD-10 CodesAim: To evaluate the utilization and outcomes of cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) by USA region, using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Patients & methods: All TAVR discharge encounters from June 2017–2019 were included in the analysis. Discharge encounters with bicuspid anatomy were excluded. Regional CEP utilization rates were reported. For TAVR cases performed with the Sentinel CEP device (Boston Scientific,MA, USA), multivariable logistic regression was performed to model regional differences in TAVR outcomes including: stroke, transient ischemic attack (TIA), stroke/TIA combined, and in-hospital all-cause mortality. Generalized linear regression models were used to assess regional differences in length of stay (LOS) and hospital charges. Results: The Northeast had the greatest overall CEP utilization rate (11.3%), followed by the Midwest (11.1%), West (8.7%), then South (3.1%). Compared with the Northeast, the South was associated with a lower risk of stroke (OR: 0.267, 95% CI: 0.106–0.673; p = 0.005), and the West a higher risk of stroke (OR: 1.583, 95% CI: 1.044–2.401; p = 0.031). Compared with the Northeast, the West was associated with a higher mrisk of stroke/TIA combined (OR: 1.618, 95% CI: 1.107–2.364; p = 0.013). Compared with the Northeast, the Midwest (OR: 4.501, 95% CI: 2.229–9.089; p < 0.001) and West (OR: 5.316, 95% CI: 2.611–10.824; p < 0.001) were associated with a higher risk of in-hospital all-cause mortality. Adjusted charges and LOS were highest in the West. Conclusion: Within the USA, there are regional differences in the utilization and outcomes of CEP use during TAVR. To prevent regional disparities and ensure consistent quality of care in the USA, further research is needed to determine what variable(s) may be responsible for regional differences in TAVR outcomes, with or without CEP.

本数据集为发表于《比较疗效研究杂志》之文章《经导管主动脉瓣置换术中脑栓塞防护措施的地区差异及其结果：2017年至2019年国家住院样本分析》的同行评审补充材料。附录表1：ICD-10编码。研究目的：通过分析美国国家住院样本（NIS）、医疗成本与利用率项目（HCUP）和医疗研究与质量管理局（AHRQ）的出院数据，旨在评估美国各地区在经导管主动脉瓣置换术（TAVR）过程中脑栓塞防护措施（CEP）的应用率和结果。研究对象与方法：将2017年6月至2019年的所有TAVR出院病例纳入分析，排除具有双瓣解剖结构的病例。报告了各地区的CEP应用率。对于使用哨兵CEP设备（波士顿科学公司，马萨诸塞州，美国）进行的TAVR病例，通过多变量逻辑回归模型来模拟TAVR结果的地区差异，包括：中风、短暂性脑缺血发作（TIA）、中风/TIA合并以及住院期间的全因死亡率。使用广义线性回归模型来评估地区差异在住院时间（LOS）和医院费用方面的差异。研究结果：东北部地区的CEP总体应用率最高（11.3%），其次是中西部（11.1%）、西部（8.7%），然后是南部（3.1%）。与东北部相比，南部地区中风的风险较低（OR：0.267，95% CI：0.106–0.673；p = 0.005），而西部地区中风的风险较高（OR：1.583，95% CI：1.044–2.401；p = 0.031）。与东北部相比，西部地区中风/TIA合并的风险较高（OR：1.618，95% CI：1.107–2.364；p = 0.013）。与东北部相比，中西部（OR：4.501，95% CI：2.229–9.089；p < 0.001）和西部地区（OR：5.316，95% CI：2.611–10.824；p < 0.001）住院期间的全因死亡率风险较高。调整后的费用和住院时间在西部地区最高。研究结论：在美国，TAVR过程中CEP应用率和结果存在地区差异。为了消除地区差异并确保美国护理质量的一致性，需要进一步研究以确定可能导致TAVR结果地区差异的变量（或变量组合），无论是否使用CEP。