title: Predictors of hospital length of stay after implantation of a left ventricular assist device: an analysis of the INTERMACS registry.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois. Electronic address: william.cotts@advocatehealth.com.
authors.forename: William G
authors.initials: WG
authors.lastname: Cotts
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Ilinois.
authors.forename: Edwin C
authors.initials: EC
authors.lastname: McGee
authors.affiliation: Cardiovascular Surgery Research, University of Alabama at Birmingham, Alabama.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Myers
authors.affiliation: Cardiovascular Surgery Research, University of Alabama at Birmingham, Alabama.
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.affiliation: Department of Medicine, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Department of Cardiothoracic Surgery, University of Alabama, Birmingham, Alabama.
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Ilinois.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D059035:Perioperative Period; D057234:Preoperative Period; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: continuous flow; heart failure; length of stay; mechanical circulatory support; ventricular assist device