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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Discharge and Readmissions After Ventricular Assist Device Placement in the US Pediatric Hospitals: A Collaboration
David W Bearl1, Brian Feingold2, Angela Lorts3
1From the Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Insights
Discharging children on ventricular assist devices (VADs) is increasing, but readmissions for heart failure, infection, or hematologic issues are common. However, mortality risk after readmission remains low for pediatric VAD patients.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Quality Improvement in Healthcare
Background:
- Ventricular assist devices (VADs) improve quality of life for children with advanced heart failure.
- Optimizing VAD management and discharge protocols is crucial for pediatric patients.
Purpose of the Study:
- To analyze discharge and readmission rates for pediatric patients on VAD support.
- To identify common reasons for readmission and associated outcomes in this population.
Main Methods:
- Retrospective analysis of pediatric VAD patients (ages 10-21) from 2009-2018 using the Pediatric Health Information System database.
- Kaplan-Meier method used to assess freedom from readmission.
- Comparison of discharged vs. non-discharged patients.
Main Results:
- Over 54% of pediatric VAD patients were discharged, with discharges increasing significantly from 2009-2012 to 2013-2018.
- Two-thirds of discharged patients were readmitted, primarily for heart failure, infection, or hematologic concerns.
- In-hospital mortality on readmission was low (1.8%), with a median length of stay of 6 days.
Conclusions:
- Pediatric VAD discharges are rising, but readmission rates remain high, necessitating improved outpatient care strategies.
- While readmissions are frequent, the risk of mortality is low, highlighting the need for continued research and collaboration.
- Center-specific variability in discharge rates underscores the importance of shared best practices and interventions to optimize VAD care.
Abstract:
Discharging children on ventricular assist device (VAD) support offers advantages for quality of life. We sought to describe discharge and readmission frequency in children on VAD support. All VAD-implanted patients aged 10-21 years at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers were identified from the Pediatric Health Information System database (2009-2018). Discharge frequency on VAD was calculated. Patients discharged on VAD were compared with those not discharged. Freedom from readmission was assessed using the Kaplan-Meier method. A total of 298 VAD-implanted patients from 25 centers were identified, of which 163 (54.7%) were discharged. Discharges increased over time (36.9% [2009-2012] vs. 59.7% [2013-2018], p = 0.001). Of 144 discharged patients with follow-up, 96 (66.7%) were readmitted for reasons other than transplantation. Heart failure was the most common reason for readmission (27.7%), followed by infection (25.8%) and hematologic concerns (16.8%). In-hospital mortality on readmission was uncommon (1.8%) and the median length of stay was 6 days (interquartile range 2-19 days). Discharge of children on VAD support has increased over time, although variability exists across centers. Readmissions are common with diverse indications; however, the risk of mortality is low. Further interventions, including collaboration in ACTION, are critical to increasing discharges and optimizing outpatient management.
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