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OUTCOMES OF WEEKEND ADMISSIONS FOR LOWER GASTROINTESTINAL HEMORRHAGE AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN THE UNITED STATES
Chung-Jyi Tsai*, Rocio Lopez
Cleveland Clinic, Cleveland, OH
Background & Aims:
Continuous-flow left ventricular assist devices (LVAD) are becoming the standard of care for managing refractory advanced heart failure. Adverse events in LVAD patients remain high. Lower GI hemorrhage (LGIH) after LVAD is a significant source of morbidity and mortality. Day of admission during weekdays or weekend (weekend effect) is associated with various clinical outcomes. It is unknown if weekend effect exists in LVAD patients with LGIH.
Methods:
Information on hospital admissions was collected from the Nationwide Inpatient Sample (NIS) from 2002 to 2011. NIS is the largest all-payer database within US with more than 1,000 hospitals sampled to represent approximately 20% of all hospital discharges each year. Patients were selected by querying all 15 procedural codes for the ICD-9-CM codes for LVAD. LGIH and obesity were defined using ICD-9-CM diagnosis codes. A modified Charlson Comorbidity Index (CCI) was calculated using the NIS Disease Severity Measure files. Logistic and linear regression models with SAS programming were used to analyze the effects.
Results:
A total of 13,607 patients had LVAD procedures from 2002 to 2011. 3,923 of these (29%) had LGIH during the same admission. 12% of these were weekend admissions while 88% were weekday admissions. Weekend admissions were more likely to be non-elective and in hospitals of larger bed size than weekday admissions. Patients admitted on weekends tended to have acute renal failure, acute respiratory failure, and use of mechanical ventilation for more than 96 hours. In the multivariable analysis, compared with patients admitted on weekdays, patients admitted on weekends had no significant differences in mortality rates, endoscopy therapy rates, and length of hospital stay. In-hospital endoscopy rates were not related to mortality rates. The in-hospital mortality among obese patients admitted on weekends (10.3%) was slightly higher than that (8%) of the non-obese but statistically insignificant.
Conclusions:
LVAD patients with LGIH admitted on weekends, compared with those patients admitted on weekdays, had similar mortality rates, endoscopy therapy rates, and lengths of stay. In-hospital endoscopy rates were unrelated to mortality rates.
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