Tu1156 THE IMPACT OF ANESTHESIA PRACTICE MODELS ON THE EFFICIENCY OF AN ENDOSCOPY UNIT

Abstract

findings (ejection fraction (EF) and right ventricular (RV) dysfunction), presenting symptom, blood transfusion, anticoagulation prior to index GIB, goal therapeutic INR, medications (PPIs and NSAIDs), days hospitalized, labs at index bleed (creatinine, platelet, albumin, bilirubin), endoscopic characterization (location, intervention, lesion description, endoscopic approach), and Charleston Comorbidity Index (CCI). Predictors for index GIB were analyzed using student's t-test for continuous variables and chisquared for categorical variables. Multivariate logistic regression analysis was created using only statically significant dependent variables and adjusted for demographic variables. Results: Thirty six percent of all patients developed a GIB (77/214). The average duration of LVAD for patients with GIB was 28.14 months compared to 11.12 months for those without GIB (p<0.01). Destination therapy (OR 3.04, 95% CI: 1.3-7.0, pZ0.01), longer duration of LVAD (OR 1.02, 95% CI: 1.002-1.040, pZ0.03), and low albumin (<3.5g/dL) (OR 5.11, 95% CI: 2.4-10.7, p<0.001) were found to be associated with increased risk of index GIB (Table 2). CCI, heart failure etiology, and Medicare were predictors of index GIB on univariant anaylsis but this was not seen on multivariate analysis (Table 1). Conclusions: This study highlights that duration of LVAD support as well as LVAD intent (destination therapy) are associated with increased risk of index GIB. Destination therapy likely reflects a higher burden of co-morbid disease in this population. Albumin is a potentially modifiable risk factor, and likely contributes to bleeding through nutrition, surrogate marker for systemic illness, as well as pharmacologic implications. Given the number of non-modifiable risk factors and heterogeneity of this population, future prospective studies should focus on treatment options for these patients.