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Published on: July 20, 2022
Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost
Shahab A Akhter1, Abbasali Badami1, Margaret Murray1
1Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Unplanned hospital readmissions after continuous-flow (CF) left ventricular assist device (LVAD) implantation were common, mainly due to gastrointestinal bleeding and driveline infections. However, these readmissions did not negatively impact long-term survival for CF-LVAD patients.
Area of Science:
- Cardiology
- Medical Devices
- Health Services Research
Background:
- Continuous-flow (CF) left ventricular assist devices (LVADs) are crucial for end-stage heart failure management.
- Unplanned hospital readmissions pose a significant challenge, impacting patient outcomes and healthcare costs.
Purpose of the Study:
- To determine the incidence and causes of unplanned readmissions following CF-LVAD implantation.
- To analyze the effect of readmissions on post-implantation survival.
- To assess the financial burden associated with readmission causes.
Main Methods:
- Retrospective review of 126 patients implanted with CF-LVADs between January 2007 and December 2013.
- Evaluation of readmission timing, hospital length of stay, and total device support duration.
- Analysis of direct hospital costs linked to each readmission event.
Main Results:
- 68 patients experienced 156 readmissions (2.2 per patient); 44% readmitted within 30 days.
- Leading causes: gastrointestinal bleeding (19%), driveline infection (13%), stroke (8%).
- Median readmission cost: $7,546; device malfunction and arrhythmias were most expensive. No significant survival difference between readmitted and non-readmitted patients.
Conclusions:
- Gastrointestinal bleeding and CF-LVAD infections are primary drivers of readmission.
- Patients spend 93% of their time out of hospital, and readmissions do not diminish long-term survival.
- Minimizing adverse events is key to enhancing CF-LVAD therapy efficacy and reducing costs.
Background:
We investigated the incidence and causes of unplanned hospital readmissions after continuous-flow (CF) left ventricular assist device (LVAD) implantation. We also analyzed the impact of unplanned readmissions on post-CF-LVAD survival and the costs associated with each cause of readmission.
Methods:
We retrospectively reviewed 126 patients who underwent implantation with a CF-LVAD from January 2007 to December 2013. The timing of readmissions, hospital length of stay, and total length of device support were evaluated. Patients were followed up while receiving support, until transplantation, or until death. Direct hospital costs associated with each readmission were analyzed.
Results:
In all, 103 patients underwent implantation for bridge to transplantation and 19 patients for destination therapy; 68 patients were readmitted 156 times (2.2 times/patient) as of the end of follow-up. The median follow-up period was 11 months. While receiving device support, patients spent 93% of their time out of the hospital. The causes of readmission included gastrointestinal bleeding (19%), driveline infection (13%), and stroke (8%). The median time to first readmission was 35 days. Thirty (44%) patients were readmitted within 30 days after discharge. The median direct hospital cost of a single readmission was $7,546. Device malfunction and arrhythmias were the most costly causes of readmission. There was no significant difference in long-term survival between readmitted patients and those who were not readmitted.
Conclusions:
Gastrointestinal bleeding and CF-LVAD-related infections were the leading causes of readmission. Patients with a CF-LVAD spent 93% of their time out of hospital after implantation, and readmissions did not have a negative impact on long-term survival. New approaches to minimize these adverse events will continue to improve the efficacy and decrease the cost of CF-LVAD therapy.
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