Increased Resource Utilization in Left Ventricular Assist Device Patients with Gastrointestinal Bleeding Compared to Medical Controls

Abstract

There is significant interest in the cost of left ventricular assist device (LVAD) therapy for treatment of end-stage heart failure. However, little is known about the costs of caring for gastrointestinal (GI) bleeding after LVAD, a common complication. Resource utilization for evaluation and management of GI bleeding patients with an LVAD is higher than in a group of medical inpatients without LVAD. Consecutive patients who were hospitalized for GI bleeding at our medical center from 2006 to 2011 were identified. Procedures, blood product transfusion, length of stay and direct hospital cost represent resource utilization. Of 670 consecutive patients admitted for GI bleeding, 24 were those with an LVAD implant. This LVAD group tended to require higher numbers of diagnostic and therapeutic procedures (3 vs. 1; p=0.02) and red blood cell transfusion (75% vs. 49%; p=0.001) compared to those in the non-LVAD group. Furthermore, LVAD patients had longer length of hospital stay (7 vs. 2 days; p<0.0001) and greater direct admission cost ($9,765 vs. $4,594; p<0.0001) (Table). Further evaluation of the LVAD group found that dominant expenses were room and board charges ($2,961, 30%) and procedures ($2,296, 24%). Arteriovenous malformation (AVM) was the most common cause of GI bleeding (n=16, 67%) in patients with LVAD. This patient subgroup required more red blood cell transfusion (94%) compared to 38% of LVAD patients with non-AVM bleeding (p=0.003). Furthermore, AVM bleeders were likely to experience longer hospital stay (8 vs. 4 days; p=0.53) and accrued higher hospital expenses ($11,101 vs. $4,919; p=0.13), although these differences did not reach statistical significance (Table). The cost of management of GI bleeding following LVAD is higher than in a group of non-LVAD medical controls, and is particularly high for the subgroup with bleeding from AVM.Table (287)Procedures, Blood Product Transfusion, Length of Stay and Direct Hospital Cost in Study patients and LVAD Patients with AVM bleeding with non-AVM BleedingNon LVAD patients n=646LVAD patients n=24P valueaAVM bleeding n=16Non-AVM BleedingP value**Procedures0.9±0.73.3±2.00.022.0±1.716±0.90.63PRC, %49750.00194380.003LOS, days2[3-5]7[2-9]<0.00018[5.9]4[2-9]0.53Direct cost, $4,634[2,611-8,177]9,765[5,563-16,693]<0.000111,101[6,671-17,544]4,919[3,601-7,016]0.13*Comparison between patients with and without LVAD.**Comparison between patients with AVM and non-AVM bleeding.Abbreviations:AVM=arteriovenous malformation; FFP=fresh frozen plasma; LOS=length of stay, LVAD=left ventricular assist devices; RBC=red blood cell. Open table in a new tab