Factors determining post-operative readmissions after left ventricular assist device implantation
Background In the current era of extensive healthcare reform, there has been a heightened focus on the frequency and cause for readmissions within 30 days of discharge given that readmissions are not reimbursed by most providers. The aim of our study was to determine the frequency, etiology and patt...
Saved in:
Published in | The Journal of heart and lung transplantation Vol. 33; no. 10; pp. 1041 - 1047 |
---|---|
Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.10.2014
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Background In the current era of extensive healthcare reform, there has been a heightened focus on the frequency and cause for readmissions within 30 days of discharge given that readmissions are not reimbursed by most providers. The aim of our study was to determine the frequency, etiology and patterns of 30-day readmissions among recipients of continuous-flow left ventricular assist devices (LVADs) at our institution as well to determine whether there were any significant predictors of readmission. Methods From March 2006 through June 2013, 150 patients underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on their 30-day readmission status. A total of 12 patients died before discharge and were excluded from our analysis. Causes for 30-day readmissions and duration of hospital stay for the readmissions were recorded. Numerous pre-operative variables and post-operative complications were compared using 2-sided t -tests and chi-square tests between patients who were and were not readmitted within 30 days of their discharge after their LVAD implant. Results The 30-day readmission rate was 26.1% (36 of 138), with approximately 70% of post-operative readmissions occurring within 10 days of the patient’s initial hospital discharge. Recurrent heart failure (12 of 36, 33.3%) and gastrointestinal bleeding (8 of 36, 22.2%) were the most common causes for 30-day readmission. The median length of stay (LOS) for readmission was 11.7 days. Thirty-day readmission did not affect short- or long-term survival. On univariate analysis, post-operative gastrointestinal bleeding (GIB) was a significant risk factor for 30-day readmissions (HR 1.4, 95% CI 0.19 to 0.99, p = 0.05), and overall length of stay was a significant factor in reducing 30-day readmission rates (HR 0.91, 95% CI 0.85 to 0.99, p = 0.02). Conclusions Our experience indicates that 30-day readmission rates after LVAD implantation remain relatively high, with most occurring within 10 days of discharge. Recurrent heart failure and GIB were the most common causes of post-operative rehospitalization. In addition, GIB during the index hospitalization was a significant predictor of 30-day readmission. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1053-2498 1557-3117 |
DOI: | 10.1016/j.healun.2014.05.009 |