Etiology and Timing of Readmissions After LVAD Implantation

Abstract

Background: Patients who undergo left ventricular assist device (LVAD) implantation require very close medical follow-up given their risk for severe complications. Readmission for inpatientmanagement is often required if acute complications develop. Readmissions after LVAD implantation are an important cause of morbidity, and may be a significant personal and financial burden for patients. In this study, we characterized LVAD readmissions by reason for admission, duration of admission, and timing of readmission. Methods: Data were collected for 94 consecutive patients who underwent HeartMate II LVAD implantation at a single center. Five patients were excluded due to death or explantation before discharge after initial implantation. Follow-up was censored at death, transplant, or explantation. Readmissions were classified by reason for admission: cardiac, bleeding, thrombosis, pump malfunction, infection, neurologic, renal, elective, and other. Total days of inpatient care were calculated for each readmission. Time from discharge of initial implantation to time of readmission were calculated for heart failure (HF), GI bleeds (GIB), neurologic, and thrombotic causes for readmission. Results: In the patient cohort of 89 patients who survived to discharge after implantation, there were 239 readmissions, comprising 1765 days of inpatient care. The distribution of readmissions by type is in table 1. Total follow-up time for all patients was 405.4 days. The distribution of initial readmissions for GIB, HF, thrombosis, and neurologic readmissions may be seen in Graph 1. Average total days of follow-up for these patients are as follows: GIB patients were followed for an average of 535.7 days (SE: 77.1), HF patients for an average of 524.2 days (SE: 101.0), neurologic patients for an average of 522.1 days (SE: 101.3), and thrombosis patients for an average of 439.9 days (SE: 120.2). Conclusion: These data demonstrate that cardiac and bleeding readmissions are the predominant reason for readmission after LVAD implantation. Pump malfunction is not a common cause for readmission, but is responsible for a disproportionate fraction of days as inpatient. The timing of readmissions demonstrates that complications typically begin within the first 100 days of the postoperative course of the LVAD implantations. Neurologic readmissions overwhelmingly occur within this period, whereas thrombotic readmissions are less concentrated in this period. Further work to determine how to reduce readmissions in LVAD patients is needed.