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 J. Derose, Alexis Neill, Edlira Dobrev, Kim T. Baio, Wendy Taddei-PetersAlan J. Moskowitz, Patrick T. O'Gara

Research output: Contribution to journalArticle

40 Scopus citations

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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ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Iribarne, A., Chang, H., Alexander, J. H., Gillinov, A. M., Moquete, E., Puskas, J. D., Bagiella, E., Acker, M. A., Mayer, M. L., Ferguson, T. B., Burks, S., Perrault, L. P., Welsh, S., Johnston, K. C., Murphy, M., Derose, J. J., Neill, A., Dobrev, E., Baio, K. T., ... O'Gara, P. T. (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, 98(4), 1274-1280. https://doi.org/10.1016/j.athoracsur.2014.06.059