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 Conclusions: Combined clinical and accurate cost data reveal critical drivers of total hospital costs.