Discharge and Readmissions after VAD Placement in US Pediatric Hospitals: A Collaboration in ACTION.

PURPOSE: There is a concerted effort to increase discharges of children on ventricular assist device (VAD) support. Optimizing this process represents a quality improvement target of Advanced Cardiac Therapies Improving Outcomes Network (ACTION). We sought to describe discharge and readmission frequency in children on VAD support using a multicenter administrative database.

METHODS: All VAD-implanted patients aged 10-21 years at ACTION centers were identified from the Pediatric Health Information System database (2009-2018). Discharge frequency on VAD was calculated. Patients discharged on VAD were compared to those not discharged. Freedom from readmission was assessed using the Kaplan Meier method, censoring at readmission for transplantation. The indications for readmission were determined using ICD diagnosis codes.

RESULTS: A total of 298 patients from 25 centers were identified, of which 163 (54.7%) were discharged. The discharge frequency ranged from 8% to 100% across centers. The frequency of discharge increased over time (36.9% [2009-2012] vs. 59.7% [2013-2018], p=0.001). Of 144 discharged patients with follow-up data, 96 (66.7%) were readmitted for reasons other than transplantation with a median time to readmission of 45 days (IQR 18-79) [Figure]. Heart failure was the most common reason for readmission (27.7%), followed by infection (25.8%), hematologic concerns (16.8%), neurologic events (8.6%), arrhythmias (7.8%), and fluid/electrolyte problems (4.7%). In-hospital mortality on readmission was uncommon (1.8%) and the median length of stay was 6 days (IQR 2-19 days).

CONCLUSION: Patients discharged with VADs from ACTION centers has increased over time, with high variability across centers. Readmissions are common with diverse indications; however, the risk of mortality during a readmission encounter is low. Further collaboration in ACTION is critical to optimize the outpatient management of this vulnerable population.