TY - JOUR
T1 - Readmissions after cardiac surgery
T2 - Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network
AU - Iribarne, Alexander
AU - Chang, Helena
AU - Alexander, John H.
AU - Gillinov, A. Marc
AU - Moquete, Ellen
AU - Puskas, John D.
AU - Bagiella, Emilia
AU - Acker, Michael A.
AU - Mayer, Mary Lou
AU - Ferguson, T. Bruce
AU - Burks, Sandra
AU - Perrault, Louis P.
AU - Welsh, Stacey
AU - Johnston, Karen C.
AU - Murphy, Mandy
AU - Derose, Joseph J.
AU - Neill, Alexis
AU - Dobrev, Edlira
AU - Baio, Kim T.
AU - Taddei-Peters, Wendy
AU - Moskowitz, Alan J.
AU - O'Gara, Patrick T.
N1 - Funding Information:
The design and outcomes of the prospective observational cohort study, Management Practices and the Risk of Infections Following Cardiac Surgery ( ClinicalTrials.gov Identifier: NCT01089712 ), have been previously reported [11] . Briefly, the study was conducted at 10 centers participating in the CTSN (funded by the National Institutes of Health and the Canadian Institutes of Health Research) in the United States and Canada. Inclusion criteria were any cardiac surgical intervention and age 18 years or older. Patients with active systemic infection, including endocarditis, at the time of their operation were excluded. The primary objective of the cohort study was to identify management practices associated with risk for infection.
Funding Information:
This research was supported by the grant award 5 U01 HL088942 and was conducted under a memorandum of understanding involving the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the Canadian Institutes of Health Research.
Publisher Copyright:
© 2014 by The Society of Thoracic Surgeons.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Results. The overall rate of readmission was 18.7%(number of readmissions, 945).Whenstratified by the mostcommon procedure type, readmission rates were isolatedcoronary artery bypass grafting, 14.9% (n [ 248); isolatedvalve, 18.3% (n[337); and coronary artery bypass graftingplus valve, 25.0% (n[169). The three mostcommoncausesof first readmission within 30 days were infection (17.1%[n [ 115]), arrhythmia (17.1% [n [ 115]), and volumeoverload (13.5% [n [ 91]). More first readmissionsoccurred within 30 days (80.6% [n[672]) than after 30 days(19.4% [n [ 162]), and 50% of patients were readmittedwithin 22 days from the index operation. The medianlength of stay during the first readmission was 5 days.Discharge in 15.8% of readmitted patients (n[128) was toa location other than home. Baseline patient characteristicsassociated with readmission included female gender, diabetesmellitus on medication, chronic obstructive pulmonarydisease, elevated creatinine, lower hemoglobin, andlonger operation time. More complex surgical procedureswere associated with an increased risk of readmissioncompared with the coronary artery bypass graftinggroup.Conclusions. Nearly 1 of 5 patients who undergo cardiacoperations require readmission, an outcome with significanthealth and economic implications. Managementpractices to avert in-hospital infections, reduce postoperativearrhythmias, and avoid volume overload offerimportant targets for quality improvement.Background. Readmissions are a common problem incardiac surgery. The goal of this study was to examine thefrequency, timing, and associated risk factors for readmissionafter cardiac operations.Methods. A 10-center cohort study prospectivelyenrolled 5,158 adult cardiac surgical patients (5,059included in analysis) to assess risk factors for infectionafter cardiac operations. Data were also collected on allcausereadmissions occurring within 65 days after theoperation. Major outcomes included the readmission ratestratified by procedure type, cause of readmission, lengthof readmission stay, and discharge disposition afterreadmission. Multivariable Cox regression was used todetermine risk factors for time to first readmission.
AB - Results. The overall rate of readmission was 18.7%(number of readmissions, 945).Whenstratified by the mostcommon procedure type, readmission rates were isolatedcoronary artery bypass grafting, 14.9% (n [ 248); isolatedvalve, 18.3% (n[337); and coronary artery bypass graftingplus valve, 25.0% (n[169). The three mostcommoncausesof first readmission within 30 days were infection (17.1%[n [ 115]), arrhythmia (17.1% [n [ 115]), and volumeoverload (13.5% [n [ 91]). More first readmissionsoccurred within 30 days (80.6% [n[672]) than after 30 days(19.4% [n [ 162]), and 50% of patients were readmittedwithin 22 days from the index operation. The medianlength of stay during the first readmission was 5 days.Discharge in 15.8% of readmitted patients (n[128) was toa location other than home. Baseline patient characteristicsassociated with readmission included female gender, diabetesmellitus on medication, chronic obstructive pulmonarydisease, elevated creatinine, lower hemoglobin, andlonger operation time. More complex surgical procedureswere associated with an increased risk of readmissioncompared with the coronary artery bypass graftinggroup.Conclusions. Nearly 1 of 5 patients who undergo cardiacoperations require readmission, an outcome with significanthealth and economic implications. Managementpractices to avert in-hospital infections, reduce postoperativearrhythmias, and avoid volume overload offerimportant targets for quality improvement.Background. Readmissions are a common problem incardiac surgery. The goal of this study was to examine thefrequency, timing, and associated risk factors for readmissionafter cardiac operations.Methods. A 10-center cohort study prospectivelyenrolled 5,158 adult cardiac surgical patients (5,059included in analysis) to assess risk factors for infectionafter cardiac operations. Data were also collected on allcausereadmissions occurring within 65 days after theoperation. Major outcomes included the readmission ratestratified by procedure type, cause of readmission, lengthof readmission stay, and discharge disposition afterreadmission. Multivariable Cox regression was used todetermine risk factors for time to first readmission.
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U2 - 10.1016/j.athoracsur.2014.06.059
DO - 10.1016/j.athoracsur.2014.06.059
M3 - Article
C2 - 25173721
AN - SCOPUS:84908079539
SN - 0003-4975
VL - 98
SP - 1274
EP - 1280
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -
