Supplementary Material for: Length of Stay in Older Patients Undergoing Transcatheter Aortic Valve Replacement: Value of a Geriatric Approach

<b><i>Background:</i></b> For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. <b><i>Methods:</i></b> This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. <b><i>Results:</i></b> median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (<i>p</i> value = 0.02), prior major neurocognitive disorders (<i>p</i> value = 0.01), femoral access (<i>p</i> value &lt;0.001), all complications (<i>p</i> value &lt;0.001), and discharge in a rehabilitation center (<i>p</i> value &lt;0.001). One-fourth (27%) of the patients had at least 1 geriatric complication. After CGA, 69 patients did not need any geriatric recommendation, whereas for the 127 other patients, an individualized-care plan was established but only 46 (36%) of them were followed up. <b><i>Conclusion:</i></b> Our results favor the preoperative screening for major neurocognitive disorders in order to reduce LOS. Furthermore, the proposed individual-care plans after CGA were poorly followed. Practitioners may perceive the preoperative CGA as a screening tool, but its primary objective is to develop an individualized-care plan as a prehabilitation plan in order to optimize the physical, functional, and social issues.

<b><i>背景：</i></b> 对于接受经导管主动脉瓣置换术（transcatheter aortic valve replacement, TAVR）的患者而言，住院时长（length of stay, LOS）延长与长期死亡率升高存在相关性。本研究的核心目的为分析老年重症主动脉瓣狭窄患者接受TAVR治疗时，老年相关因素与住院时长之间的关联。<b><i>方法：</i></b> 本回顾性单中心研究纳入了2018年1月至2019年1月期间接受TAVR治疗的所有75岁及以上患者。研究针对术前系统性全面老年评估（comprehensive geriatric assessment, CGA）中记录的老年相关因素，分析了患者的住院时长与术后并发症情况；同时也对术前CGA制定的个体化照护方案进行了分析。<b><i>结果：</i></b> 纳入的196例患者的住院时长中位数为6天（四分位距：4~8），其中29%的患者出现住院时长延长。多变量分析显示，与住院时长延长相关的术前因素包括欧洲心脏手术风险评估系统Ⅰ（EuroSCORE I）（P=0.02）、既往重度神经认知障碍（P=0.01）、股动脉入路（P<0.001）、各类术后并发症（P<0.001）以及出院至康复中心（P<0.001）。四分之一（27%）的患者至少出现1项老年相关并发症。完成CGA后，69例患者无需任何老年医学干预建议；其余127例患者制定了个体化照护方案，但其中仅46例（36%）得到了依从执行。<b><i>结论：</i></b> 本研究结果支持术前筛查重度神经认知障碍以缩短住院时长。此外，术前全面老年评估后拟定的个体化照护方案依从性较差。临床从业者可能将术前CGA视为一种筛查工具，但其核心目标是制定个体化照护方案作为术前康复计划，以优化患者的躯体、功能与社会层面的状态。