Predictors of Length of Stay in Hospital After Transcatheter Aortic Valve Replacement: Impact of Naples Prognostic Score

Abstract

Background and Objectives: Preoperative systemic inflammation and nutritional status are known to affect prognosis and length of hospital stay (LoS) in patients undergoing transcatheter aortic valve replacement (TAVR). The Naples Prognostic Score (NPS) is a simple and effective scoring system that assesses both nutrition and inflammation, and has been shown to predict prognosis in various clinical settings. We aimed to determine the effect of NPS on LoS in patients undergoing TAVR. Materials and Methods: A total of 405 patients who underwent TAVR were retrospectively divided into two groups based on length of stay: early discharge (LoS <= 3 days) and late discharge (LoS > 3 days). The NPS was calculated prior to the TAVR procedure. Results: In the late discharge group (n = 164, 40.6%), patients were found to have significantly higher values for age, NYHA functional class, STS risk score, systolic pulmonary artery pressure, white blood cell count, neutrophil count, monocyte count, creatinine, glucose, NLR, rate of surgical access site, incidence of major/minor access site and structural complications, myocardial infarction, cerebrovascular events, acute kidney injury, major bleeding, blood transfusion, pacemaker implantation, and elevated NPS (p < 0.05). When independent risk factors for late discharge were evaluated, in addition to reduced eGFR, surgical closure of the access site, history of cerebrovascular events, need for pacemaker implantation, and blood transfusion, a high Naples Prognostic Score was also identified as an independent risk factor for prolonged hospital stay after TAVR in the multivariate logistic regression analysis (p < 0.05). Conclusions: A high Naples Prognostic Score (NPS), which reflects systemic inflammation and nutritional status, is associated with delayed hospital discharge and is an independent risk factor in patients undergoing TAVR.