The following is a summary of “EGS plus: Predicting futility in LVAD patients with emergency surgical disease,” published in the December 2022 issue of Surgery by Place, et al.

Even though LVAD patients can undergo emergency, non-cardiac surgery without risk, surgeons may be reluctant to perform necessary emergency general surgery (EGS) procedures due to the perioperative difficulties associated with the uncommon procedures and the perception that the patients may not be good surgical candidates. To aid in perioperative decision-making, researchers thus aimed to identify predictors of inpatient mortality.

Patients with previously implanted LVADs and a later EGS admission diagnosis were found using the Nationwide Inpatient Sample (2010-2015Q3). To find independent predictors of 30-day mortality, multivariable logistic regression analysis was used. For significant patient subgroups across ages, a risk-adjusted probability of death was determined. Due to their clinical significance, additional demographic factors were added to the regression.

The total death rate for 1,805 (weighted) LVAD-EGS patients was 11%. Intestinal ischemia and sepsis evident at entry served as independent predictors of death. Patients over 70 who had sepsis had an 80% chance of dying in the hospital (10.6 OR, 1.70-65.5 95% CI), but those who had intestinal ischemia had a 38% chance of dying (3.6 OR, 1.50-8.78 95% CI). The mortality risk for younger sepsis patients remained over 50%.

While younger patients had a moderate risk, older LVAD patients who arrived with either sepsis or intestinal ischemia had a significant mortality risk. Therefore, when emergency surgery for LVAD patients is being considered, the findings can be utilized to inform therapy considerations.

Reference: americanjournalofsurgery.com/article/S0002-9610(22)00659-6/fulltext