Original article
Adult cardiac
Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis

https://doi.org/10.1016/j.athoracsur.2015.03.010Get rights and content

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.

Section snippets

Patients and Methods

Between January 2007 and December 2013, 126 patients underwent implantation with a CF-LVAD at the University of Wisconsin Hospital and Clinics. This study was approved by our Institutional Review Board (IRB). The data were prospectively acquired and maintained in our IRB-approved VAD database. The cohort was divided into two groups: (1) the group of patients who were readmitted to the hospital while using device support and (2) the group of patients who were never readmitted to the hospital

Results

Our study population consisted of 126 consecutive CF-LVAD patients. Four patients who died before discharge during the index hospitalization were excluded from the analysis. Indications at device implantation included bridge to transplantation (BTT) in 103 (84%) patients and destination therapy (DT) in 19 patients (16%). The median age of the patients was 55 years (mean, 53 ± 13 years), and 16% were female. The cause of cardiomyopathy was ischemic in 55 patients (45%). Three different devices

Comment

Mechanical circulatory support devices have been used for patients with end-stage heart failure over a few decades. The transition from pulsatile to CF-LVADs has been associated with a significant decline in overall rates of adverse events, significantly improved durability, and much better long-term survival for both the bridge to transplantation and destination therapy indications [2]. Although CF-LVADs have considerably improved clinical outcomes and patient survival, there is no doubt that

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