Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding.
Dig Dis Sci
; 62(1): 150-160, 2017 01.
Article
em En
| MEDLINE
| ID: mdl-27858326
ABSTRACT
BACKGROUND:
Left ventricular assist devices (LVADs) are being utilized for management of end-stage heart failure and require systemic anticoagulation. Gastrointestinal bleeding (GIB) is one of the most common adverse events following LVAD implantation.AIM:
To investigate the impact of continuous-flow (CF) LVAD implants on outcomes of patients admitted with GIB.METHODS:
This is a cross-sectional study utilizing the Nationwide Inpatient Sample in the CF-LVAD era from 2010 to 2012. All adult admissions with a primary diagnosis of GIB were included. Among hospitalizations with GIB, patients with (cases) and without (controls) CF-LVAD implants were compared using univariate and multivariate analyses. The main outcome measurements were in-hospital mortality, length of stay, and hospitalization costs.RESULTS:
Among 1,002,299 hospitalizations for GIB, 1112 (0.11%) patients had CF-LVADs. Bleeding angiodysplasia accounted for a majority of GIB in CF-LVAD patients (35.4% of 1112). Multivariate analysis adjusting for demographic, hospital and etiological differences, site of GIB, and patient comorbidities revealed that CF-LVADs were not adversely associated with mortality in GIB (OR 0.53, 95% CI 0.07-4.15). However, CF-LVADs independently accounted for prolonged hospitalization (3.5 days, 95% CI 2.6-4.6) and higher hospital charges ($37,032, 95% CI $7991-$66,074).CONCLUSIONS:
In patients admitted with GIB, CF-LVAD implantation accounts for higher healthcare utilization, but is not adversely associated with mortality despite therapeutic anticoagulation, increased comorbidities, and comparatively delayed endoscopy. These findings are relevant as CF-LVADs are the dominant type of LVAD and are associated with increased risk of GIB compared to their predecessors.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Coração Auxiliar
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Preços Hospitalares
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Recursos em Saúde
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Insuficiência Cardíaca
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Hemorragia Gastrointestinal
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Tempo de Internação
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Anticoagulantes
Tipo de estudo:
Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article