{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:08:41Z","timestamp":1791410921237,"version":"4.3.3"},"reference-count":66,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,9]],"date-time":"2023-07-09T00:00:00Z","timestamp":1688860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative for stroke prevention in patients with atrial fibrillation (AF) not suitable for anticoagulation therapy. Real-world data on peri-procedural outcomes are limited. The aim of this study was to analyze outcomes of peri-procedural safety and healthcare resource utilization in 11,240 adult patients undergoing LAAC in the United States between 2016 and 2019. Primary outcomes (safety) were in-hospital ischemic stroke or systemic embolism (SE), pericardial effusion (PE), major bleeding, device embolization and mortality. Secondary outcomes (resource utilization) were adverse discharge disposition, hospital length of stay (LOS) and costs. Logistic and Poisson regression models were used to analyze outcomes by adjusting for 10 confounders. SE decreased by 97% between 2016 and 2019 [95% Confidence Interval (CI) 0\u20130.24] (p = 0.003), while a trend to lower numbers of other peri-procedural complications was determined. In-hospital mortality (0.14%) remained stable. Hospital LOS decreased by 17% (0.78\u20130.87, p &lt; 0.001) and adverse discharge rate by 41% (95% CI 0.41\u20130.86, p = 0.005) between 2016 and 2019, while hospital costs did not significantly change (p = 0.2). Female patients had a higher risk of PE (OR 2.86 [95% CI 2.41\u20136.39]) and SE (OR 5.0 [95% CI 1.28\u201343.6]) while multi-morbid patients had higher risks of major bleeding (p &lt; 0.001) and mortality (p = 0.031), longer hospital LOS (p &lt; 0.001) and increased treatment costs (p = 0.073). Significant differences in all outcomes were observed between male and female patients across US regions. In conclusion, LAAC has become a safer and more efficient procedure. Significant sex differences existed across US regions. Careful considerations should be taken when performing LAAC in female and comorbid patients.<\/jats:p>","DOI":"10.3390\/jcm12144573","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:54:23Z","timestamp":1688950463000},"page":"4573","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Safety and Healthcare Resource Utilization in Patients Undergoing Left Atrial Appendage Closure\u2014A Nationwide Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4698-4079","authenticated-orcid":false,"given":"Tharusan","family":"Thevathasan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"},{"name":"Berlin Institute of Health, Anna-Louisa-Karsch-Stra\u00dfe 2, 10178 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"},{"name":"Institute of Medical Informatics, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00eahnou","family":"Degbeon","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6528-8872","authenticated-orcid":false,"given":"Julia","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius-Konstantin","family":"Wendelburg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"F\u00fcreder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Leonie","family":"Gaul","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5835-4627","authenticated-orcid":false,"given":"Jan F.","family":"Scheitz","sequence":"additional","affiliation":[{"name":"Berlin Institute of Health, Anna-Louisa-Karsch-Stra\u00dfe 2, 10178 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"},{"name":"Department of Neurology and Center for Stroke Research Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertraud","family":"Stadler","sequence":"additional","affiliation":[{"name":"Research Unit Gender in Medicine, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andi","family":"Rroku","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9166-1258","authenticated-orcid":false,"given":"Sonia","family":"Lech","sequence":"additional","affiliation":[{"name":"Institute for Medical Sociology and Rehabilitation Science, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"Department of Psychiatry and Neurosciences, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4545-2575","authenticated-orcid":false,"given":"Pichit","family":"Buspavanich","sequence":"additional","affiliation":[{"name":"Research Unit Gender in Medicine, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"Institute for Sexology and Sexual Medicine, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Campus Mitte, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Huemer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Attanasio","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Nagel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Reinthaler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Landmesser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"},{"name":"Berlin Institute of Health, Anna-Louisa-Karsch-Stra\u00dfe 2, 10178 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Skurk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990\u20132017: A Systematic Analysis for the Global Burden of Disease Study 2017","volume":"392","author":"James","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.amjcard.2013.05.063","article-title":"Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. Adult Population","volume":"112","author":"Colilla","year":"2013","journal-title":"Am. 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