Preoperative End-organ Perfusion Is Associated With Perioperative Left Ventricular Assist Device Length Of Stay

Introduction Although left ventricular assist devices (LVADs) can be life-saving for patients with end-stage heart failure, LVAD implantation can be associated with a lengthy perioperative hospitalization. Few studies have evaluated predictors of length of stay (LOS). Therefore, we undertook this study to evaluate preoperative variables associated with perioperative LOS. Methods We undertook a retrospective study of all LVAD implants from 2017-2022. Perioperative length of stay in days was collected and divided into categories: preoperative LOS, postoperative LOS, and total LOS. LOS is presented as median values with interquartile ranges. Comparisons are performed using the Kruskal-Wallis test. Multivariable linear regression models were created to evaluate predictors of length of stay. Results From 2017-2022, 96 LVADs were implanted. Operative mortality was 10.42%. The total perioperative LOS was 27 [20-39] days while the preoperative LOS was 9 [6-12.5] days and the postoperative LOS was 18 [13-27] days (Figure). Although patients who suffered an operative mortality tended to have longer preoperative (8.5 [6-13] vs. 9.5 [4-10], p=0.718), postoperative (18 [13-27] vs. 34 [10-39], p=0.133), and total LOS (27 [20-38] vs. 37.5 [13-50], p=0.346), this difference did not reach statistical significance. On multivariable analysis, preoperative creatinine (4.35 [0.17-8.54], p=0.042), bilirubin (2.76 [0.43-5.10], p=0.021), and hematocrit (-0.61 [-1.08- -0.14], p=0.011) were all associated with total LOS (Table). Preoperative bilirubin (2.15 [1.08-3.22], p<0.001) was associated with longer pre-implantation LOS while preoperative creatinine (3.88 [0.71-7.05], p=0.017) was associated with longer post-implant LOS. Higher preoperative hematocrit was associated with both a shorter total (-0.61 [-1.08- -0.14], p=0.11) and shorter postoperative LOS (-0.46 [-0.82- -0.10], p=0.012). Conclusions Although perioperative LVAD implantation LOS is largely driven by the postoperative LOS, preoperative LOS can also be significant. Preoperative measures of end-organ perfusion, particularly serum creatinine and bilirubin, are strongly associated with an increased LOS. A higher preoperative hematocrit appears protective.