Abstract 18827: Critical Preoperative Factors and Specific Postoperative Adverse Events Drive Left Ventricular Assist Device Implant Hospitalization Costs.
Introduction: The cost of LVAD’s and subsequent care results in unfavorable economic evaluations of cost-effectiveness. Cost estimates for LVAD implant hospitalization, however, have been based upon assumptions from CMS data using inpatient-billing codes. Specific hospital costs can be obtained through a detailed cost accounting system in order to determine the effects of pre-implant characteristics and adverse events (AE’s) occurring during implant hospitalization that drive costs.
Hypothesis: We will identify a subset of pre-operative characteristics and subsequent AE’s that results in higher costs during implant hospitalization.
Methods: 80 patients received a rotary LVAD at a single institution (April 2013 to November 2015). Controllable cost obtained from a hospital cost management system was combined with patient demographics, pre-operative characteristics, AE’s and long-term follow-up data. The outcome variable was the cost of implant hospitalization, while the predictors were pre-operative characteristics and subsequent AE’s. Multivariable linear regression analysis was used to identify the strongest independent predictors of cost and to quantify the additional cost associated with pre-specified AE’s including infection, bleeding/tamponade, reoperation, respiratory events, renal failure, stroke, need for RVAD or RV failure, and arrhythmias.
Results: The mean and median costs for LVAD implant hospitalization were: $219,866 +/- $67,203 and $194,728 (range: $129,733 - $464, 982) respectively. Adjusting for age, device type, emergent status, and intention-to-treat, strong pre-implant drivers of cost in multivariable analysis included pre-op ventilator ($125,348 additional cost; p<0.0001) and ischemic diagnosis ($34,372 additional cost; p=0.01). When controlling for the multiple adverse events above the most significant drivers of cost were the need for any reoperation (increased cost by $29, 835; <0.02), and the presence of any RV failure (increased cost by $32, 846; p<0.03). In a univariable model other AEs’ that raised cost were; infection ($45,500), respiratory failure ($74,223), and renal failure ($58,525).
Conclusions: Combined clinical and accurate cost data reveal critical drivers of total hospital costs.
Author Disclosures: C.V. Nikas: None. J.O. Larsen: None. J.J. Teuteberg: Speakers Bureau; Modest; Heartware Inc, Caredex,. Consultant/Advisory Board; Modest; Heartware Inc, Abiomed, CAreDx, Acorda Therapeutics. Other; Modest; CEC St Jude/Abbott. L.G. Lagazzi: None. A.D. Althouse: None. M. Sharbaugh: None. M.A. Shullo: None. K.L. Lockard: None. E.M. Dunn: None. N.M. Kunz: None. R.L. Kormos: Other; Modest; HeartWare Inc, Travel for meetings.
- © 2016 by American Heart Association, Inc.