Causes and predictors of 30-day readmissions in patients with cardiogenic shock requiring extracorporeal membrane oxygenation support

Abstract

Background: Cardiogenic shock is associated with significant mortality, morbidity, and healthcare cost. Utilization of extracorporeal membrane oxygenation in cardiogenic shock has increased in the United States. We sought to identify the rates and predictors of hospital readmissions in patients with cardiogenic shock after weaning from extracorporeal membrane oxygenation. Methods: Using the 2016 Nationwide Readmission Database, we identified all patients (⩾18 years) with cardiogenic shock (ICD-10 CM R57.0) that have been implanted with extracorporeal membrane oxygenation (ICD-10-PSC of 5A15223) and were discharged alive (January–November 2016). We explored the rates, causes, and predictors of all-cause readmissions within 30 days. Results: Out of 69,040 admissions with cardiogenic shock, 1641 (2.4%) underwent extracorporeal membrane oxygenation (581 were implanted during or after cardiac surgery). A total of 734 (44.7%) patients of all extracorporeal membrane oxygenations survived to discharge, and 661 were available for analysis. Out of those, 158 (23.9%) were readmitted within 30 days of discharge. More than 50% of these readmissions happened within the first 11 days. Out of 158 patients who were readmitted, 12 (7.4%) died during the readmission hospitalization. Leading causes of readmission were cardiovascular (31.6%) (heart failure: 24.1%, arrhythmia: 20.6%, neurovascular: 10.3%, hypertension: 10.3%, and endocarditis: 6.8%), followed by complications of medical/device care (17.7%), infection (11.3%), and gastrointestinal/liver (10.1%) complications. Factors associated with readmissions include the following: discharge to skilled nursing facility or with home healthcare (odds ratio: 2.10; 95% confidence interval: 1.18–3.74), durable ventricular assisted device implantation, asthma, and chronic liver disease. Conclusion: Patients with cardiogenic shock who underwent extracorporeal membrane oxygenation had a readmission rate. Identifying patients at high risk of readmissions might help improve outcomes.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Of six adult ECMO studies investigating mortality, five observed patients (83%) with higher SES measured by ZIP code median income or Medicare wage index had improved survival (88, 103, 122–124). Three showed no association with other outcomes (complications or readmissions) (56, 65, 125, 126). One study incorporating all ages (127) and four pediatric studies found no association between SES and outcomes (31, 77, 86, 107).…”

“…Eight studies reported improved survival in patients with private relative to government insurance (28,77,88,89,106,123,128,129). Eight found no survival difference (55, 65, 81, 92, 130-133), with variable cost, complication, readmission, and LOS results (31,33,56,70,125,126,128,134), including one with higher renal replacement in privately insured patients (83).…”

Machine learning based predictive modeling of readmissions following extracorporeal membrane oxygenation hospitalizations

“…With the aim of directing efforts for quality improvement, prior work has sought to delineate clinical factors associated with nonelective rehospitalization following ECMO [ 4 ]. Current models, however, remain limited due to the use of older, highly selective, or pediatric cohorts, thus reducing generalizability without accounting for local variations in clinical practice.…”