Longer and Shorter Hospital Stay after Heart Transplant Both Risk Factors for Suboptimal Outcome

Abstract

Purpose Length of hospital stay (LOS) may be associated w/adverse outcome after heart transplantation (HTx). Patients (pts) who have a longer hospital stay may have complications during hospitalization thereby increasing risk for morbidity and mortality in the ensuing months/years. Early hospital discharge has also not been established to be optimal, as immunosuppression may not be stabilized in this short period. Trends for hospital LOS after HTx have not been established. Methods and Materials Between 1994 and 2010, we evaluated 1,212 HTx pts and divided them into 3 LOS groups ( 14 days). Outcome for all pts included 5-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events and 1st year freedom from any treated rejection. Results The average LOS for each group was: 14 days = 29.1 ± 28.9 days. For pts with LOS >14 days there was significant reduction in 5-year actuarial survival and freedom from NF-MACE compared to the other two groups. In the LOS Conclusions Hospital LOS >14 days appears to be associated w/poor outcome after HTx most likely due to complications exhibited during the original hospitalization. Pts with short LOS ( Outcomes LOS LOS 7-14 days (n=678) LOS > 14 days (N=420) Log-Rank p-value 5-Year Actuarial Survival 82% 81% 75% 0.038 5-Year Freedom from CAV 67% 74% 77% 0.238 5-Year Freedom from NF-MACE 87% 86% 80% 0.016 1-Year Freedom from Any-Treated Rejection 72% 83% 82% 0.089 Length of Stay LOS LOS 7-14 days (n=678) LOS > 14 days (N=420) Mean LOS, Days ± SD 5.7 ± 0.5 9.7 ± 1.9 29.1 ± 28.9 Median LOS, Days 6 10 20