Effect of Vitamin D Supplementation on Aortic Stiffness and Arterial Hemodynamics in People With Osteoarthritis and Vitamin D Deficiency.
range of 11.8% to 25.6%, and 30-day RSRR was 20.9% (20.2% to 22.1%) with a range of 17.1% to 24.4%. The top 7 principal diagnoses for these readmissions were heart failure (4.8% of all readmissions), postoperative complications such as shock, hematoma, wound dehiscence, and infection (1.4%), arrhythmias (1.1%), sepsis (0.9%), pneumonia (0.8%), gastrointestinal bleed (0.6%), and mechanical device complications (0.5%). Adjusting for patient characteristics, the odds of each adverse outcome for a patient treated at a hospital 1 SD above the national average relative to that of a patient treated at a hospital 1 SD below the national average was statistically significant (Figure 1). Since the Food and Drug Administration approval of TAVR in November 2011, there has been rapid expansion in the number of hospitals performing TAVR. Our results show marked variation in hospital performance with TAVR, with an IQR of 1.8% for 30day RSMR. For perspective, the IQR for 30-day RSMR for isolated coronary artery bypass grafting, a commonly performed invasive cardiac procedure, is 1% (4). We found that for an individual patient, the between-hospital variation translates to a >2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below. The between-hospital variation was lower for 1-year mortality and 30-day readmission, but remained substantial. Some of this betweenhospital variation can be attributed to clinical factors insufficiently captured by our adjustment model, but hospital and system factors are likely also important drivers of this variation. In addition, TAVR volume and duration of center experience were not assessed and could influence outcomes. As the importance of hospital and system factors was not investigated in this paper henceforth, the conclusions of this paper reflect the authors’ opinion. This study serves as an important benchmark for quality measurement and future performance improvement efforts for TAVR. Moving forward, as more centers and operators begin performing TAVR, and existing centers and operators become more proficient, it will be important to continue to monitor the extent of hospital variation to ensure the delivery of optimal outcomes for patients.