Readmissions after cardiac surgery

Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network

Alexander Iribarne, Helena Chang, John H. Alexander, A. Marc Gillinov, Ellen Moquete, John D. Puskas, Emilia Bagiella, Michael A. Acker, Mary Lou Mayer, T. Bruce Ferguson, Sandra Burks, Louis P. Perrault, Stacey Welsh, Karen C. Johnston, Mandy Murphy, Joseph DeRose, Alexis Neill, Edlira Dobrev, Kim T. Baio, Wendy Taddei-Peters & 2 others Alan J. Moskowitz, Patrick T. O'Gara

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1274-1280
Number of pages7
JournalAnnals of Thoracic Surgery
Volume98
Issue number4
DOIs
StatePublished - Oct 1 2014

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National Institutes of Health (U.S.)
Thoracic Surgery
Health
Coronary Artery Bypass
Cross Infection
Quality Improvement
Cardiac Arrhythmias
Creatinine
Hemoglobins
Cohort Studies
Arteries
Economics
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Readmissions after cardiac surgery : Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network. / Iribarne, Alexander; Chang, Helena; Alexander, John H.; Gillinov, A. Marc; Moquete, Ellen; Puskas, John D.; Bagiella, Emilia; Acker, Michael A.; Mayer, Mary Lou; Ferguson, T. Bruce; Burks, Sandra; Perrault, Louis P.; Welsh, Stacey; Johnston, Karen C.; Murphy, Mandy; DeRose, Joseph; Neill, Alexis; Dobrev, Edlira; Baio, Kim T.; Taddei-Peters, Wendy; Moskowitz, Alan J.; O'Gara, Patrick T.

In: Annals of Thoracic Surgery, Vol. 98, No. 4, 01.10.2014, p. 1274-1280.

Research output: Contribution to journalArticle

Iribarne, A, Chang, H, Alexander, JH, Gillinov, AM, Moquete, E, Puskas, JD, Bagiella, E, Acker, MA, Mayer, ML, Ferguson, TB, Burks, S, Perrault, LP, Welsh, S, Johnston, KC, Murphy, M, DeRose, J, Neill, A, Dobrev, E, Baio, KT, Taddei-Peters, W, Moskowitz, AJ & O'Gara, PT 2014, 'Readmissions after cardiac surgery: Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network', Annals of Thoracic Surgery, vol. 98, no. 4, pp. 1274-1280. https://doi.org/10.1016/j.athoracsur.2014.06.059
Iribarne, Alexander ; Chang, Helena ; Alexander, John H. ; Gillinov, A. Marc ; Moquete, Ellen ; Puskas, John D. ; Bagiella, Emilia ; Acker, Michael A. ; Mayer, Mary Lou ; Ferguson, T. Bruce ; Burks, Sandra ; Perrault, Louis P. ; Welsh, Stacey ; Johnston, Karen C. ; Murphy, Mandy ; DeRose, Joseph ; Neill, Alexis ; Dobrev, Edlira ; Baio, Kim T. ; Taddei-Peters, Wendy ; Moskowitz, Alan J. ; O'Gara, Patrick T. / Readmissions after cardiac surgery : Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 4. pp. 1274-1280.
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abstract = "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.",
author = "Alexander Iribarne and Helena Chang and Alexander, {John H.} and Gillinov, {A. Marc} and Ellen Moquete and Puskas, {John D.} and Emilia Bagiella and Acker, {Michael A.} and Mayer, {Mary Lou} and Ferguson, {T. Bruce} and Sandra Burks and Perrault, {Louis P.} and Stacey Welsh and Johnston, {Karen C.} and Mandy Murphy and Joseph DeRose and Alexis Neill and Edlira Dobrev and Baio, {Kim T.} and Wendy Taddei-Peters and Moskowitz, {Alan J.} and O'Gara, {Patrick T.}",
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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

AU - Neill, Alexis

AU - Dobrev, Edlira

AU - Baio, Kim T.

AU - Taddei-Peters, Wendy

AU - Moskowitz, Alan J.

AU - O'Gara, Patrick T.

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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