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Plastic Surgery Involvement With Surgical Management Of Infected Ventricular Assist Devices Decreased Lifetime Return To Or Without Increase In 90 Day Complications.
Keith Sweitzer, MD, James Butterfield, MD, Cody Fowler, MD, Danielle Mayorga-Young, BS, Julia Tomtschik, BS, Racquel Arias-Camison, BS, Derek Bell, MD;
University of Rochester, Rochester, NY, USA
Purpose: The use of ventricular assist devices (LVADs) for patients with end-stage cardiac failure has become increasingly common. However, ventricular assist device-related infections remain a major problem. We wished to determine if early plastic surgery intervention led to a decreased length of stay for these patients.
Methods: LVAD patients readmitted for LVAD infection at a single institution from 2008-2021. Patients were followed retrospectively for an average of 3.2 years. Patient demographics, preoperative diagnosis/disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, definitive device coverage, timing of coverage procedure after the initial washout for infection, type of flap used for coverage, 90 day complications following definitive coverage and lifetime return to OR for infection was reviewed. Comparison analysis with Chi squared and ANOVA testing was used to analyze outcomes.
Results: 568 patients admitted with an LVAD infection, 104 underwent operative debridement and closure. 53 with PRS, 51 with CTS. There was an increased incidence of diabetes among the PRS group (p <.001). There was increased RTOR over a lifetime with CTS closure compared to PRS (p=0.03), and increased 90 day risk of infection (p=0.007). PRS closure patients had an increased risk of post-operative hematoma (p=046). PRS was typically consulted on hospital day 10. PRS and CTS closure patients were discharged on POD7 on average (p=0.542)
Conclusion: Plastic Surgery involvement with surgical decision making/flap coverage of infected LVAD devices has a decrease in lifetime RTOR. There may be a benefit to earlier PRS consultation for coverage assessment.
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