Highlights
- •Morality for EGS patients with LVADs is acceptably low and should not necessarily preclude surgical intervention.
- •Preoperative sepsis and intestinal ischemia are independent predictors of mortality in EGS patients with LVADs.
- •LVAD patients over the age of 70 with sepsis have a conditional probability of death of greater than 80%.
Abstract
Background
While emergent, non-cardiac surgery can be safely performed in LVAD patients, the
inherent perioperative challenges of these rare procedures and the perception that
these patients may be poor surgical candidates can contribute to reluctance to perform
necessary emergency general surgery (EGS) procedures. We, therefore, sought to identify
predictors of inpatient mortality to assist perioperative decision-making.
Methods
The Nationwide Inpatient Sample (2010-2015Q3) was used to identify patients with previously
placed LVADs with a subsequent EGS admission diagnosis. Multivariable logistic regression
analysis was performed to identify independent predictors of 30-day mortality, and
a risk-adjusted probability of death was calculated for significant patient subgroups
across age. Additional demographic variables were included in the regression due to
clinical relevance.
Results
There were 1805 (weighted) LVAD-EGS patients with an overall mortality rate of 11%.
Independent predictors of mortality were intestinal ischemia and sepsis present on
admission. Patients older than 70 with sepsis had an 80% probability of in-hospital
mortality (10.6 OR, 1.70–65.5 95% CI) while those over 70 presenting with intestinal
ischemia had a 38% probability of death (3.6 OR, 1.50–8.78 95% CI). Mortality risk
for younger patients with sepsis was still approximately 50%.
Conclusion
Older LVAD patients presenting with either sepsis or intestinal ischemia have a substantial
mortality risk while younger patients have a modest risk. These results can be used
to guide treatment discussions when emergency surgery is being considered in LVAD
patients.
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Article info
Publication history
Published online: October 16, 2022
Accepted:
October 13,
2022
Received in revised form:
October 3,
2022
Received:
March 26,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
