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Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding

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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.

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Author contributions

FL performed conception and design, analysis and interpretation of the data, drafting of the article, and critical revision of the article for important intellectual content; AH conducted analysis and interpretation of the data, drafting of the article, and critical revision of the article for important intellectual content; AC was involved in analysis and interpretation of the data, and drafting of the article; NM, SE, CZ, HH, and DC took part in critical revision of the article for important intellectual content; SK carried out conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA

    Feng Li, Samer Eldika, Cheng Zhang, Hisham Hussan, Darwin L. Conwell & Somashekar G. Krishna

  2. Division of Biostatistics, College of Public Health, The Ohio State University, 241-2 Cunz Hall, 1841 Neil Ave., Columbus, OH, 43210, USA

    Alice Hinton

  3. Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 3rd Floor Office Tower, Columbus, OH, 43210, USA

    Alan Chen

  4. Division of Cardiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Nishaki K. Mehta

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  1. Feng Li
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  2. Alice Hinton
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  3. Alan Chen
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Correspondence to Somashekar G. Krishna.

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Li, F., Hinton, A., Chen, A. et al. Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding. Dig Dis Sci 62, 150–160 (2017). https://doi.org/10.1007/s10620-016-4379-8

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  • DOI: https://doi.org/10.1007/s10620-016-4379-8

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