OBJECTIVES

To determine the factors influencing the probability to start rehabilitation after surgical aortic valve replacement (SAVR) and to identify the factors affecting index hospitalization and rehabilitation length of stay (LOS).

METHODS

We retrospectively analyzed all SAVR performed in Italy in 2009-2015 as reported in the National Hospital Discharges database. We performed linear and logistic regression analyses to explore the determinants of LOS and rehabilitation probability respectively.

RESULTS

Our sample consists of 113,849 patients who underwent AVR, of which 97,571 SAVR patients. On average 64.3% patients started a rehabilitation program after SAVR. At the patient level, the probability of starting rehabilitation was significantly (p<.05) higher in older and female patients, living in Northern Italy and hospitalized in Northern regions hospitals. The probability was higher when index hospitalization occurred in public teaching hospitals and in hospitals with a long-term care facility.

The average index hospitalization and rehabilitation LOS in the sample was 15.7 (SD=12.4) and 18.9 days (SD=11.0) respectively, with a decreasing trend over time. At the individual level, index hospitalization LOS significantly increased with age, patient severity, extra-regional residence, and when hospitalization occurred in public hospitals. Northern regions hospitals tended to discharge patients earlier.

The rehabilitation LOS was significantly higher in older and female patients, and negatively influenced by extra-regional residence. The LOS was longer in teaching hospitals and when the index hospitalization occurred in hospitals with long-term care facilities. The latter might be due to rehabilitation pathway starting during the index hospitalization.

CONCLUSIONS

Rehabilitation is a key factor that facilitates patients’ recovery. The knowledge of the factors, both at patient and institutional level, that impact on the decision to start a rehabilitative program after SAVR are relevant to inform evidence-based policies aimed at encouraging the most appropriate clinical pathway, reducing uneven access to care across different areas.