Validation of days alive and out of hospital as a new patient-centered outcome to quantify life impact after heart transplantation

Abstract

The number of patients waiting for heart transplantation (HTX) is increasing. Thus, identification of outcome-relevant factors is crucial. This study aimed to identify perioperative factors associated with days alive and out of hospital (DAOH)—a patient-centered outcome to quantify life impact—after HTX. This retrospective cohort study screened 187 patients who underwent HTX at university hospital Duesseldorf, Germany from September 2010 to December 2020. The primary endpoint was DAOH at 1 year. Risk factors for mortality after HTX were assessed in univariate analysis. Variables with significant association were entered into multivariable quantile regression. In total, 175 patients were included into analysis. Median DAOH at 1 year was 295 (223–322) days. In univariate analysis the following variables were associated with reduced DAOH: recipient or donor diabetes pre-HTX, renal replacement therapy (RRT), VA-ECMO therapy, recipient body mass index, recipient estimated glomerular filtration rate (eGFR) and postoperative duration of mechanical ventilation. After adjustment, mechanical ventilation, RRT, eGFR and recipient diabetes showed significant independent association with DAOH. This study identified risk factors associated with reduced DAOH at 1-year after HTX. These findings might complement existing data for outcome of patients undergoing HTX.

Days alive and out of hospital for children born with single-ventricle heart disease

“…By excluding patients who did not survive their index hospitalisation, we were able to identify factors that affect longterm days alive and out of hospital. 26 This identified that gestational age and presence of non-cardiac anatomic defects were associated with increased rehospitalization and thus fewer days alive and out of hospital, while hybrid Norwood and right ventricular dominance no longer impacted days alive and out of hospital if a patient survived index hospitalisation. This change in variable significance of non-cardiac anatomic abnormalities in adjusted analyses has also been demonstrated in a study by Alsoufi et al 27 It is possible that children with extra-cardiac defects, after surviving their index hospitalisation, require a higher level of general care that contributes to more frequent hospitalisations in this population.…”

Association between early postoperative hypoalbuminaemia and outcome after orthotopic heart transplantation

“…DAOH were calculated by subtraction of all days spent in the hospital from 365 days. In case of death, the days the patient did not survive were added to the time spent in the hospital which was then subtracted from 365 days [ 13 , 14 ]. DAOH is a more patient-centred outcome as it includes mortality, length of hospital stay and hospital readmissions and is known for its correlation with measures of quality of life [ 11 ].…”