Murat SEZGİN, Murat Bülent RABUŞ, Emre SELÇUK, Özge ALTAŞ, Sabit SARIKAYA, Mehmet BALKANAY, MEHMET KAAN KIRALİ

The analysis of unplanned readmissions after left ventricular assist device implantation as bridge-to-transplant

Background: In this study, we aimed to investigate frequency,patterns, etiologies, and costs of unplanned readmissions after leftventricular assist device implantation.Methods: Between April 2012 and September 2016, 99 unplannedreadmissions of a total of 50 consecutive bridge-to-transplantpatients (45 males, 5 females; mean age 46.9±10.3 years; range, 19to 67 years) who were successfully discharged after left ventricularassist device implantation were retrospectively analyzed. Patientdemographic data, hemodynamic measurements before implantation,and readmissions after discharge were recorded. Hospitalizationsdue to major problems which were unable to be managed in routineoutpatient clinic were accepted as unplanned readmissions. Survivalanalysis was performed.Results: The readmission rate was 1.7 per year after discharge.Survival of patients who were readmitted within the first 90 days wasfound to be significantly lower than those without early readmission.The most common reasons of readmissions during follow-up weremajor infection (23.2%), neurological dysfunction (22.2%), cardiaccauses (12.1%), bleeding (11.1%), and device malfunction (10.1%).Neurological dysfunctions (82,005 USD) and device malfunctions(73,300 USD) caused the highest economic burden.Conclusion: Among patients with a left ventricular assist device,hospital readmissions are common. Development of preventivestrategies as well as effective treatment methods focused on longtermadverse events is critical to reduce the frequency and costs ofhospital readmissions.

Transplantasyona köprüleme olarak sol ventrikül destek cihazı yerleştirilmesi sonrası planlanmamış hastane başvurularının analizi

Amaç: Bu çalışmada sol ventrikül destek cihazı implantasyonu sonrasında planlanmamış hastane başvurularının sıklığı, paternleri, nedenleri ve maliyetleri araştırıldı. Çalışma planı: Nisan 2012 - Eylül 2016 tarihleri arasında sol ventrikül destek cihazı implantasyonu sonrasında başarılı bir şekilde taburcu edilen toplam 50 ardışık transplantasyona köprüleme hastasının (45 erkek, 5 kadın; ort. yaş 46.9±10.3 yıl; dağılım, 19-67 yıl) 99 planlanmamış hastane başvurusu retrospektif olarak incelendi. Hastaların demografik özellikleri, implantasyon öncesinde hemodinamik ölçümleri ve taburculuk sonrasında yeniden hastane başvuruları kaydedildi. Rutin poliklinikte tedavi edilemeyen majör nedenlere bağlı hastane yatışları, planlanmamış hastane başvurusu olarak kabul edildi. Sağkalım analizi yapıldı. Bulgular: Taburculuk sonrası tekrar hastaneye başvuru oranı yıllık 1.7 idi. İlk 90 gün içinde hastane başvurusu olan hastaların sağkalım süresi, erken başvuru yapmayan hastalara göre anlamlı düzeyde düşük bulundu. Takip sırasında en sık hastaneye yeniden başvuru nedenleri enfeksiyon (%23.2), nörolojik disfonksiyon (%22.2), kardiyak nedenler (%12.1), kanama (%11.1) ve cihaz malfonksiyonu (%10.1) idi. Nörolojik disfonksiyon (82.005 USD) ve cihaz malfonksiyonu (73.300 USD) en yüksek ekonomik yüke neden oldu. Sonuç: Sol ventrikül destek sistemi cihazı olan hastalar arasında tekrar hastane başvurusu sıktır. Hastane yatışlarının sıklığını ve maliyetini azaltmak için önleyici stratejilerin yanı sıra, uzun dönem advers olaylara yönelik etkili tedavi stratejilerinin geliştirilmesi önemlidir.

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