Abdominal Operations After Left Ventricular Assist Device Implantation and Heart Transplantation
| Autor: | Ricardo Rosales Morales, Hanning Xing, Ravi Morchi, Peyman Benharash, William S. Ragalie, Yas Sanaiha |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_specialty genetic structures medicine.medical_treatment 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine Laparotomy medicine Humans Digestive System Surgical Procedures Retrospective Studies Heart transplantation business.industry Incidence (epidemiology) Immunosuppression Odds ratio Middle Aged equipment and supplies United States eye diseases 030220 oncology & carcinogenesis Ventricular assist device Cardiology Heart Transplantation Female 030211 gastroenterology & hepatology Surgery Cholecystectomy Heart-Assist Devices business Complication |
| Zdroj: | Journal of Surgical Research. 243:481-487 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2019.06.045 |
| Popis: | Left ventricular assist devices (LVADs) are increasingly used to supplant the limited number of orthotopic heart transplantation (OHT). The present study aimed to perform a contemporary analysis of emergency abdominal operations after LVAD and OHT at a national level.The 2005-2015 National Impatient Sample, the largest all-payer hospitalization database in the United States, was used to identify all adult patients who had received LVAD or OHT. The primary outcome of interest was the rate of emergency general surgery (EGS), which included laparotomy, small or large bowel resection, peptic ulcer operation, adhesiolysis, and cholecystectomy, during the same hospitalization as LVAD or OHT. Logistic regression was used to determine risk factors for EGS as well as the association between EGS and mortality in both the LVAD and OHT populations.Of the estimated 19,395 OHT and 23,441 LVAD performed, 445 (2.3%) OHT and 719 (3.1%) LVAD patients required EGS. The incidence of EGS in LVAD decreased from 5.4 to 3.3%, whereas it increased among OHT patients from 1.9 to 3.7%, P = 0.003. Occurrence of EGS after OHT and LVAD was associated with significantly higher inpatient risk-adjusted mortality (OHT adjusted odds ratio, 3.0; P = 0.004; LVAD adjusted odds ratio, 2.5; P 0.001), incremental hospitalization costs (OHT, $106,778; P 0.001; LVAD, $61,965; P 0.001), and length of stay (OHT, 27.9 d; P 0.001; LVAD, 20.8 d; P 0.001).EGS remains an infrequent but high mortality and cost complication of OHT and LVAD. Further investigation of the impact of immunosuppression, anticoagulation, and perfusion strategies on incidence of abdominal complications is warranted. |
| Databáze: | OpenAIRE |
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