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Impact of 30 Day Readmission After Left Ventricular Assist Device Implantation

Gupta, Saurabh*; Cogswell, Rebecca J.; Roy, Samit S., MSPH; Spratt, John R., MD; Liao, Kenneth K., MD, PhD; Martin, Cindy M., MD; John, Ranjit, MD

doi: 10.1097/MAT.0000000000000812
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Early readmission (within 30 days) after left ventricular assist device (LVAD) implantation might be a marker for increased mortality. We retrospectively reviewed the records of 277 adults who underwent continuous-flow LVAD implantation from 2005 through 2015 at our institution. The baseline characteristics of patients who were (versus were not) readmitted within 30 days after LVAD implantation were compared. To assess the impact of 30 day readmission on long-term survival, we used multivariate Cox regression. We also compared the cardiac transplant rate between the two groups. Of the 277 patients, 217 (78.3%) underwent LVAD implantation as a bridge-to-transplant; 76 (27.4%) of the 277 were readmitted within 30 days. The most common reason for readmission was volume overload (23.6%), followed by gastrointestinal bleeding (15.8%). Male gender, previous smoking, a higher baseline creatinine level, higher Model for End Stage Liver Disease Excluding INR (MELD-XI) score, and postoperative gastrointestinal bleeding or stroke were each associated with 30 day readmission. In our final multivariate model, increased mortality was also associated with 30 day readmission (hazard ratio, 1.60; 95% confidence interval, 1.1–2.5). Among the 217 bridge-to-transplant patients, the cardiac transplant rate was similar between the two groups: 18.7 transplants per patient-year among those who were readmitted within 30 days versus 19.7 transplants per patient-year among those who were not (p = 0.26). Among our study patients, 30 day readmission after LVAD implantation was frequent and was associated with increased mortality. It is currently unclear whether the general health of those patients was a factor and whether efforts to reduce 30 day readmission would favorably affect longer-term patient outcomes.

From the *Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota

Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota.

Submitted for consideration July 2017; accepted for publication in revised form March 2018.

Disclosure: The authors report no conflicts of interest and no outside sources of funding specifically for this study. Ranjit John is a consultant for and has received research grants from Abbott (St. Jude, St. Paul, Minnesota). Rebecca J. Cogswell receives speaking fees for lecturing at Abbott (St. Jude, St. Paul, Minnesota) and for HeartMate II training sessions. All other authors have no relevant financial relationships to disclose.

The first two authors contributed equally to this work and share first authorship.

Correspondence: Saurabh Gupta, Department of Medicine, University of Minnesota, 2450 Riverside Avene, Minneapolis, MN 55454. Email: gupta172@umn.edu.

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