Purpose: No prior study has specifically investigated the effects of early mobility following left ventricular assist device (LVAD) implantation. The purpose of the present study was to describe postoperative acute care rehabilitation management of patients with LVADs and to determine whether earlier mobilization and ambulation were significant predictors of shorter Length of Stay (LOS) and discharge (DC) home. Methods: A retrospective chart review of the initial acute care stay of 98 consecutive patients with first-time HeartMate II or HeartWare LVAD implantation was performed. Multivariate linear and logistic regression models were used to control for the confounding effects of the following variables on LOS and DC home: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile, Model for End- Stage Liver Disease (MELD) score, serum albumin, number of postoperative days of impaired cognition, mechanical ventilation, and total number of adverse events. Results: The number of postoperative days until first ambulation was an independent, statistically significant predictor of both shorter LOS and likelihood of DC home, explaining an additional 15% of the variance in LOS and an additional 14% of the variance in the likelihood of DC home. The number of days until first time standing was not a statistically significant predictor of LOS or DC home. Conclusions: Earlier ambulation after LVAD implantation was predictive of shorter LOS and DC home even when controlling for several other well established pre- and postoperative determinants of clinical outcome.
Available at: http://works.bepress.com/michael_shoemaker/41/