Causes and characteristics associated with early and late readmission after open‐heart valve surgery

Abstract

Objectives The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause‐specific readmissions after open‐heart valve surgery. Methods A single‐center, retrospective cohort of 980 patients undergoing open‐heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). Results In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause‐specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18‐2.88), male gender (HR: 1.85; CI: 1.11‐3.09), high alcohol intake (HR: 1.99; CI: 1.22‐3.24) and mitral valve procedures (HR: 1.86; CI: 1.11‐3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53‐5.63), mitral valve procedures (HR: 2.10; CI: 1.23‐3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03‐2.85) were associated with atrial fibrillation/flutter readmissions. Conclusion Predicting overall readmissions after open‐heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause‐specific readmissions.

Occurrence and predictors of pericardial effusion requiring invasive treatment following heart valve surgery

“…The incidence of significant pericardial effusion (16%) found in the current study is seemingly high when compared with previous studies 1 4–9. This can be explained by several factors: several studies report incidences of significant pericardial effusions based on broad cardiac surgical populations, including patients undergoing isolated CABG.…”

“…Thus, it is expected that our study, only including patients undergoing valve surgery, will find a higher proportion of pericardial effusions. In addition, the definition of significant pericardial effusion versus cardiac tamponade varies across studies1 4–9 18 and in the current study, all significant pericardial effusions requiring drainage were included.…”

“…Commonly, pericardial effusion develops within the first postoperative weeks and is usually diagnosed with echocardiography 3 4. Incidences of pericardial effusions in available literature vary greatly from 1% to 64%, depending on definitions, study design, observation time and surgical population studied 1 4–9. Opposed to other common complications following cardiac surgery such as atrial fibrillation, heart failure and infections, causes and characteristics of pericardial effusions have not been as thoroughly investigated 4…”

Frequency and risk factors of Unplanned 30-day readmission after Open heart surgeries: A retrospective study in A tertiary-Care-Center.

“…Among patients admitted for open-heart surgery, the readmission rate in our study was 16.3%. Similarly, a retrospective study gathered in New York, United States, showed the readmission rate was 16.5% (12) . On the other hand, a separate study in Florida, United States, was 23% (16) .…”

“…Lowering hospital readmission rates has been considered an effective method to enhance the quality of care and reduce costs (11) . Nevertheless, a retrospective cohort study in the United States between January 1, 2005, and November 30, 2007, showed that the 30-day readmission rate after cardiac surgery ranged from 8.3% to 21.1%, with the most common reasons for readmission being postoperative infection (16.9%) and heart failure (12.8%) (12) . Iribarne and colleagues in a prospective study reported that the overall rate of readmission was 18.7% with female gender, diabetes mellitus, COPD, elevated creatinine, and lower hemoglobin being the top most common risk factors for re-admission after cardiac surgery (13) .…”