H. Xing1, Y. Sanaiha1, B. Kavianpour1, S. E. Rudasill1, A. L. Mardock1, H. Khoury1, R. Morchi2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2University Of California – Irvine,General Surgery,Orange, CA, USA
Introduction:
Ventricular assist devices (VAD) are increasingly used to supplant the limited number of heart transplants (OHT). Given variable diaphragmatic implantation sites and the potential for low flow and embolism, VAD patients have been demonstrated to require emergency general surgery (EGS) in small series. The present study aimed to evaluate the perioperative incidence of EGS, after VAD and OHT, and explore its impact on patient outcomes.
Methods:
The 2005-2015 National Impatient Sample, an all-payer hospitalization database in the U.S, was utilized to identify all adult patients who had received VAD or OHT. Patients receiving both modalities during the same hospitalization were excluded. The primary outcome of interest was the rate of EGS (small and large bowel resection, cholecystectomy, ulcer procedures, and lysis of adhesions) after VAD or OHT during the same hospitalization. We employed univariate analysis to compare VAD and OHT patients who received EGS, considering over 30 comorbidities as well as hospital factors. Logistic regression was used to determine risk factors for EGS as well as the association between EGS and mortality in both the VAD and OHT populations.
Results:
In this study, an estimated 23,440 patients underwent VAD implantation and 19,391 had OHT, with VAD patients having a higher rate of EGS (2.7 vs 1.9%, p=0.012). Among VAD patients, EGS decreased by 0.2% annually (p<0.001) while the OHT group exhibited a steady trend. On average, VAD patients with EGS were older (58.7 vs 53.7 y, p=0.007) but had a similar Elixhauser comorbidity index (4.2 vs 4.0, p<0.361) compared to the OHT/EGS group. In both the VAD and OHT cohorts, requirements for EGS procedures were associated with significant unadjusted mortality (see Figure). Adjusting for patient and hospital level factors, VAD implantation was not independently predictive of EGS (OR 1.2, 95% CI 0.9-1.7). Infection, peritonitis, intestinal ischemia, intestinal obstruction, and paralytic ileus were associated with increased odds of EGS for both the VAD and OHT cohorts. EGS was associated with higher odds of mortality in both the VAD (OR 1.8, 95% CI 1.1-3.0) and OHT (OR 2.8, 95% CI 1.3-5.9) cohorts.
Conclusion:
Abdominal complications necessitating EGS after VAD and OHT are associated with increased odds of adjusted mortality. Although EGS rates seem to have decreased for VAD patients, the high mortality of several EGS categories remain concerning. Management strategies that ensure adequate cardiac output, reduce thromboembolic risk, and prevent ileus may mitigate the need for EGS in this vulnerable population.
