Cotts William G, McGee Edwin C, Myers Susan L, Naftel David C, Young James B, Kirklin James K, Grady Kathleen L
Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois.
Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Ilinois.
J Heart Lung Transplant. 2014 Jul;33(7):682-8. doi: 10.1016/j.healun.2014.02.022. Epub 2014 Mar 1.
Few studies have reported on hospital length of stay (LOS) after left ventricular assist device (LVAD) implantation. The purpose of this study was to determine pre- and peri-operative predictors of hospital LOS after LVAD implantation.
We analyzed adult primary continuous-flow LVAD patients implanted between June 23, 2006 and December 31, 2010 at 105 institutions from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Retrospective analyses included measures of central tendency, frequencies, correlations and stepwise multivariable regression modeling (p ≤ 0.05). Independent variables included demographic characteristics, pre-implant clinical and behavioral variables and concomitant surgery.
Characteristics of the patients (n = 2,200) included: mean age 54.6 ± 12.6 years; 79% male; 69% white; 57% INTERMACS Profile 1 or 2; 37% diabetic; 21% with history of coronary artery bypass graft (CABG); 7% with history of valve surgery; and 37% with concomitant surgery. Median hospital LOS (implant to discharge) was 20 days. Significant predictors of an increased hospital LOS included demographic characteristics (older age and non-white), pre-implant clinical variables (history of CABG or valve surgery, diabetes, ascites, INTERMACS Profiles 1 and 2, low albumin, high blood urea nitrogen, high right atrial pressure) and concomitant surgery, explaining 12% variance (F = 22.65, p<0.001).
Demographic characteristics, pre-implant variables and concomitant surgery partially explained hospital LOS after continuous-flow LVAD implant. These variables have implications regarding selection of patients for mechanical circulatory support.
关于左心室辅助装置（LVAD）植入术后住院时间（LOS）的研究报道较少。本研究的目的是确定LVAD植入术后住院LOS的术前和围手术期预测因素。
我们分析了2006年6月23日至2010年12月31日期间在105个机构接受成人原发性连续流LVAD植入的患者，这些数据来自机构间机械辅助循环支持注册中心（INTERMACS）。回顾性分析包括集中趋势测量、频率、相关性和逐步多变量回归建模（p≤0.05）。自变量包括人口统计学特征、植入前临床和行为变量以及同期手术。
患者（n = 2200）的特征包括：平均年龄54.6±12.6岁；79%为男性；69%为白人；57%为INTERMACS Profile 1或2；37%患有糖尿病；21%有冠状动脉旁路移植术（CABG）病史；7%有瓣膜手术史；37%接受了同期手术。住院LOS中位数（从植入到出院）为20天。住院LOS增加的显著预测因素包括人口统计学特征（年龄较大和非白人）、植入前临床变量（CABG或瓣膜手术史、糖尿病、腹水、INTERMACS Profiles 1和2、低白蛋白、高血尿素氮、高右心房压）和同期手术，解释了12%的方差（F = 22.65，p<0.001）。
人口统计学特征、植入前变量和同期手术部分解释了连续流LVAD植入术后的住院LOS。这些变量对机械循环支持患者的选择具有重要意义。
