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Non-patient factors associated with infections in LVAD recipients: A scoping review

https://doi.org/10.1016/j.healun.2021.10.006Get rights and content

Background

Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesizes all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients.

Methods

Published studies were identified through searching 5 bibliographic databases: PubMed, Scopus, EMBASE, CINAHL, and Web of Science Core Collection. Inclusion criteria required examination of factors associated with infections among recipients of contemporary, implantable, continuous flow LVADs. Key study characteristics were extracted by 4 independent reviewers and current literature described narratively. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to develop a taxonomy for non-patient related factors (e.g., tasks, tools, technologies, organization, and environment) associated with infections following LVAD implantation. All analyses took place between February 2019 and May 2021.

Findings

A total of 43 studies met inclusion criteria. The majority of included studies were observational (n = 37), single-center (n = 29), from the U.S. (n = 38), and focused on driveline infections (n = 40). Among the 22 evaluated sub-domains of non-patient related factors, only two: increasing center experience and establishing a silicone-skin interface at the driveline exit site, were identified as consistently being associated with a lower risk of infection.

Conclusion

This review identified 43 studies that described non-patient related factors associated with infection in LVAD recipients. Only two factors were consistently associated with lower infection risk in LVAD recipients: increasing experience and establishing a silicone-skin interface at driveline exit site. The large variability in reporting across multiple studied interventions limited the ability to discern their effectiveness.

Section snippets

Study design and search strategy

This scoping review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews standards.11,12 Non-patient factors associated with infections among durable LVAD recipients were evaluated. A scoping review methodology rather than a systematic review was conducted due to lack of high-quality studies addressing the research questions and large variability in study designs, methods and definition of infections.13

Search strategy

Electronic

Overview of included studies

A total of 9,680 studies were evaluated using titles and abstracts, with 480 studies further reviewed as full text. Overall, 137 studies described infections in LVAD recipients and/or identified associated factors. This manuscript describes findings from 43 (37 observational, 6 randomized trials) unique studies (Figure 1) that examined non-patient factors associated with infections in LVAD recipients. Inter-rater reliability for screening and abstraction was high (Ƙ 0.71). Table 2 lists all

Discussion

This scoping review identified 37 observational studies and 6 randomized trials examining the association between non-patient factors and infections among LVAD recipients and has 3 important findings. First, the majority of included studies were single-center experiences focused on DLI with limited data on other infections. Second, there was significant variability in infection reporting standards, study samples and interventions that precluded drawing definitive conclusions with regard to the

Conclusions

Literature on non-patient factors associated with post-LVAD implant infections is predominantly from observational studies. A large proportion solely examined DLI and did not adhere to ISHLT reporting recommendations. This review identified 2 significant factors associated with a lower risk for infections in LVAD recipients: increasing center experience and establishing a silicone-skin interface at the driveline exit site. A wide range of surgical techniques used for LVAD implantation, varying

Author contributions

SS, MP, DSL: study conception, data acquisition and analysis, drafting initial manuscript

TMFW, GY, WAT, LC: Data acquisition, revising manuscript

MDF, CC, KDA, FDP: study conception, revising manuscript

Acknowledgments

This project was supported by grant number R01HS026003 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Conflict of interest statement

Supriya Shore is supported by American Heart Association Career Development Award (ID 855105).Donald S. Likosky receives: (i) extramural support from the Agency for Healthcare Research and Quality and National Institutes of Health; (ii) partial salary support from Blue Cross Blue Shield of Michigan; and (iii) support as a consultant to the American Society of ExtraCorporeal Technology. Keith Aaronson serves on a Medtronic Independent Physician Quality Panel. Francis D. Pagani is a member of the

Disclosures

All the other authors have no relevant disclosures.

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    Authors share first authorship equally

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