Left Ventricular Assist Device Implantation Site Volume and 30 Day Readmissions

Abstract

Introduction Readmissions within 30 days of left ventricular assist device (LVAD) implantation are common, contributing to increased morbidity and cost. The relationship between hospital volume and outcomes after LVAD implantation has not been well established. The purpose of this study was to examine 30-day readmission rates after LVAD implantation, stratified by hospital volume, using the Nationwide Readmissions Database (NRD), an all-payer administrative database. Methods Using the 2014 NRD, we examined 1,311 adults discharged following LVAD implantation in January-November 2014. We identified LVAD implantations based on ICD-9-CM procedure code 37.66 and excluded patients with concurrent ICD-9-CM codes of heart transplantation (37.51 and 33.60). LVAD site volume was determined by counting the number of LVAD implantations from January through December 2014 at each hospital. We then classified patients into site volume quartiles (≤ 23, 24-40, 41-49, and ≥ 50). To determine whether LVAD site volume was independently associated with all-cause 30-day readmission, we conducted multivariable logistic regression accounting for the sample design and adjusting for age, sex, payer status, income quartile, Elixhauser weighted comorbidity index, discharge disposition, pre-LVAD mechanical circulatory support, and length of stay. Results Among 1,311 patients discharged following LVAD implantation, 363 (27%) were readmitted within 30 days. Patients who experienced an LVAD implantation at a hospital in the lowest quartile of LVAD volume were more likely to have higher comorbidity burden, longer index hospitalization length of stay, and have had their implantation at a smaller hospital (bed size Conclusion LVAD site volume was not associated with 30-day readmission. This suggests that regulatory processes in place to ensure high quality LVAD care across sites in the United States have been effective independent of volume.