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J Thromb Thrombolysis. 2019 Apr;47(3):375-383. doi: 10.1007/s11239-018-1781-4.

Resource utilization and hospital readmission associated with gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices.

Author information

1
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2
Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC, USA.
3
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
4
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
5
Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
6
Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
7
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. mgivertz@bwh.harvard.edu.
8
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. mgivertz@bwh.harvard.edu.

Abstract

Gastrointestinal bleeding (GIB) occurs in up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs). We sought to identify targets to improve hospital resource utilization and decrease readmissions after GIB. We performed a single-center, retrospective analysis of LVAD-associated GIB resulting in hospital admission between July 2011 and April 2014. Follow-up data were collected through March 2015. We analyzed 57 admissions for GIB in 23 patients. One or more diagnostic imaging study was performed in 47% of admissions, with a definite or probable source of GIB identified in 23%. A total of 76 endoscopies were performed (≥ 1 endoscopy in 79% of admissions, ≥ 2 in 42%). Definite or probable bleeding sources were identified in 25% and 12% of endoscopies, respectively. Patients who underwent multiple endoscopies were no more likely to have a bleeding source identified (OR 1.48; 95% CI 0.50-4.32; p = 0.59) and had longer hospital stays (11.1 vs. 7.8 days, p < 0.02). Readmission rates for GIB at 30 and 90 days were 33% and 53%, respectively. A decrease in antiplatelet regimen at discharge was associated with lower rate of readmission for GIB (OR 0.16; 95% CI 0.03-0.82; p = 0.03) or any cause (OR 0.21; 95% CI 0.05-0.85; p = 0.04) at 30 and 90 days. GIB in patients with CF-LVADs is associated with significant in-hospital resource utilization and high rates of readmission. Imaging and endoscopy are common, but have low diagnostic yield and infrequently result in successful intervention. Strategies to reduce resource utilization and prevent readmission are warranted.

KEYWORDS:

Gastrointestinal bleeding; Left ventricular assist device; Readmission; Resource utilization

PMID:
30523584
DOI:
10.1007/s11239-018-1781-4
[Indexed for MEDLINE]

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