Author + information
- Katherine Lietza,b,
- Christopher Barreiroa,b,
- Jonathan Philpotta,b,
- Claudia Flinka,b,
- Michael McGratha,b and
- John Herrea,b
Background: Bleeding is the most common adverse event of left-ventricular assist device (LVAD) surgery. We examined the impact of perioperative bleeding on the costs of hospitalization for LVAD surgery.
Methods: We studied 176 consecutive LVAD recipients between 1/1/09 and 6/30/15 (163 HeartMate II and 13 HeartWare) during the implant hospitalization (median follow-up: 24 days). Direct and total costs were obtained.
Results: The majority (85%) of patients required RBCP transfusions (mean 7.3+8 units). Severity of bleeding was categorized based on number of transfused RBCP as mild (0-4 units), moderate (5-9 units) or severe (>9 units). Compared to patients with mild bleeding (n=80; 45%), those with moderate (n=47; 27%) and severe bleeding (n=49; 28%) experienced increased frequency and severity of operative complications, including surgical re-exploration*, delayed chest closure > 48 hrs*, prolonged ventilatory support > 3 days*, prolonged inotrope use > 2 weeks*, right ventricular failure requiring RVAD*, renal failure requiring dialysis*, prolonged stay in critical care unit > 1 week* and deconditioning requiring inpatient rehabilitation*. Overall, mild, moderate and severe perioperative bleeding, was associated with longer median hospital stay (19, 24 and 42 days**); increased pre-discharge mortality (1%, 2% and 20%**), increased direct hospital costs ($219,453, $241,393 and $265,127**) and increased total hospital costs ($559,389, $646,657 and $690,695**), respectively. The relationship between the severity of bleeding and costs of implant hospitalization is shown in Figure 1.
Conclusions: Perioperative bleeding with LVAD surgery is an important factor affecting patient morbidity and mortality and has a substantial impact on the costs of hospitalization. Strategies aimed at identifying patients at risk and reducing operative bleeding are key to reduced costs of device therapy.*p<.05, **p<.001
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: What Next When All Else Is Failing?
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1248-254
- 2017 American College of Cardiology Foundation