Hospital Complications and Causes of 90-Day Readmissions After Implantation of Left Ventricular Assist Devices

Authors

• Byomesh Tripathi, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York. Electronic address: vyomesh_tripathi@yahoo.com.
• Shilpkumar Arora, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
• Varun Kumar, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.Follow
• Kamia Thakur, Geisinger Health System, Danville, Pennsylvania.
• Sopan Lahewala, Jersey City Medical Center, Jersey City, New Jersey.
• Nileshkumar Patel, University of Miami/Miller School of Medicine, Miami, Florida.
• Mihir Dave, Icahn School of Medicine at Mount Sinai, New York, New York.
• Mahek Shah, Lehigh Valley Hospital, Allentown, Pennsylvania.
• Sejal Savani, Icahn School of Medicine at Mount Sinai, New York, New York.
• Purnima Sharma, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
• Dhrubajyoti Bandyopadhyay, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
• Ghanshyam Palamaner Shantha, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
• Alexander Egbe, Mayo Clinic, Rochester, Minnesota.
• Saurav Chatterjee, The Hoffman Heart and Vascular Institute at Saint Francis Hospital and Medical Center, Hartford, Connecticut.
• Nimesh Kirit Patel, Virginia Commonwealth University, Division of Cardiology, Richmond, Virginia.
• Radha Gopalan, Icahn School of Medicine at Mount Sinai, New York, New York.
• Vincent M. Figueredo, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.
• Abhishek Deshmukh, Mayo Clinic, Rochester, Minnesota.

Document Type

Article

Abstract

Left ventricular assist devices (LVADs) have emerged as an attractive option in patients with advance heart failure. Nationwide readmission database 2013 to 2014 was utilized to identify LVAD recipients using ICD-9 procedure code 37.66. The primary outcome was 90-day readmission. Readmission causes were identified using ICD-9 codes in primary diagnosis field. The secondary outcomes were LVAD associated with hospital complications. Hierarchic 2-level logistic models were used to evaluate study outcomes. We identified 4,693 LVAD recipients (mean age 57 years, 76.2% males). Of which 53.9% were readmitted in first 90 days of discharge. Cardiac causes (33.3%), bleeding (21.3%), and infections (12.4%) were leading etiologies of 90-day readmissions. Significant predictors (odds ratio, 95% confidence interval, p value) of readmission were disposition to nursing facilities (1.33, 1.09 to 1.63, p = 0.01) and longer length of stay (1.01, 1.00 to 1.01, p <0.01). Although private insurance (0.75, 0.66 to 0.86, p <0.01), and self-pay (0.58, 0.42 to 0.81, p <0.01) predicted lower readmissions. Cardiac complications (36.3%), major bleeding (29.8%), and postoperative infections (10.4%) were most common LVAD-related complications. In conclusion, high early readmission rate was observed among LVAD recipients with Cardiac complications, bleeding complications, and infections were driving force for major complications and most of readmissions.

Medical Subject Headings

Female; Follow-Up Studies; Heart Failure (surgery); Heart-Assist Devices (adverse effects); Humans; Incidence; Length of Stay (trends); Male; Middle Aged; Patient Readmission (trends); Postoperative Complications (epidemiology); Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States (epidemiology)

Publication Date

8-1-2018

Publication Title

The American journal of cardiology

E-ISSN

1879-1913

Volume

122

Issue

3

First Page

420

Last Page

430

PubMed ID

29960661

Digital Object Identifier (DOI)

10.1016/j.amjcard.2018.04.015

Recommended Citation

Tripathi, Byomesh; Arora, Shilpkumar; Kumar, Varun; Thakur, Kamia; Lahewala, Sopan; Patel, Nileshkumar; Dave, Mihir; Shah, Mahek; Savani, Sejal; Sharma, Purnima; Bandyopadhyay, Dhrubajyoti; Shantha, Ghanshyam Palamaner; Egbe, Alexander; Chatterjee, Saurav; Patel, Nimesh Kirit; Gopalan, Radha; Figueredo, Vincent M.; and Deshmukh, Abhishek, "Hospital Complications and Causes of 90-Day Readmissions After Implantation of Left Ventricular Assist Devices" (2018). Neurology. 2075.
https://scholar.barrowneuro.org/neurology/2075