Spencer W Trooboff1,2, Patrick C Magnus3, Cathy S Ross1, Kristine Chaisson4, Robert S Kramer5, Robert E Helm6, Helen Desaulniers7, Roberto C De La Rosa8, Benjamin M Westbrook7, Dennis Duquette6, Jeremiah R Brown8, Elaine M Olmstead1, David J Malenka1, Alexander Iribarne1. 1. Department of Surgery and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 2. Veterans Affairs Quality Scholars Program, Veterans Health Administration, White River Junction, Vermont. 3. Center for Cardiac Care, Concord Hospital, Concord, New Hampshire. 4. Heart and Vascular Institute, Central Maine Medical Center, Lewiston, Maine. 5. Division of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine. 6. Coastal Cardiothoracic & Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, New Hampshire. 7. New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire. 8. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Abstract
BACKGROUND: Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value-oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. METHODS: Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients' medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. RESULTS: Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4-16 days) and only 13% of patients were evaluated in-office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. CONCLUSIONS: Ensuring early follow-up for high-risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.
BACKGROUND: Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value-oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. METHODS: Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients' medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. RESULTS: Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4-16 days) and only 13% of patients were evaluated in-office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. CONCLUSIONS: Ensuring early follow-up for high-risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.
Authors: Britt Borregaard; Jordi S Dahl; Ola Ekholm; Emil Fosbøl; Lars P S Riber; Kirstine L Sibilitz; Sasja M Pedersen; Thomas P H Rothberg; Maiken H Nielsen; Selina K Berg; Jacob E Møller Journal: PLoS One Date: 2020-10-07 Impact factor: 3.240