Effect of Gender on Unplanned Readmissions After Percutaneous Coronary Intervention (from the Nationwide Readmissions Database)

Abstract

Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs $12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes.

Etiologies, trends, and predictors of readmission in ST‐elevation myocardial infarction patients undergoing multivessel percutaneous coronary intervention

“…This gender-based disparity in readmission is likely related to high burden of comorbidities and older age of presentation in female patients as noted by previously published studies exploring readmission pattern after PCI. 12,40 The risk of readmission based on insurance type is corroborated in our study with an increased risk if the payer source was Medicare/Medicaid. Interestingly, FFR utilization during multivessel PCI did not significantly help in reducing 30-day readmission rates.…”

Assessing the impact of social determinants of health on predictive models for potentially avoidable 30-day readmission or death

“…(i.e., non-Hispanic, Hispanic, and unknown/declined/other), primary language (i.e., English vs. other), marital status (i.e., partnered vs. single), and insurance type (i.e., commercial, Medicare, Medicaid, dual-eligible for Medicare and Medicaid, and other public insurance). Prior studies have found that these variables are associated with increased risk of readmission [35][36][37][38]. For patients with missing race/ethnicity information in the EHR data, we coded their race/ethnicity as "unknown" as a separate category.…”

Sex differences in rates and causes of 30-day readmissions after cardiac electronic device implantations: insights from the Nationwide Readmissions Database

“…There is a growing interest in the study of sex differences in readmissions after cardiovascular procedures such as PCI, TAVI and catheter ablation for AF. [13][14][15] However, no study has examined these differences amongst those undergoing de novo CIED implantation. Despite the baseline differences in patients undergoing each type of procedure, sex disparities in rates and causes of readmissions have been previously observed.…”