Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

Abstract

Background Readmission after coronary artery bypass graft (CABG) surgery is associated with adverse outcomes and significant healthcare costs, and 30-day readmission rate is considered as a key indicator of the quality of care. This study aims to: quantify rates of readmission within 30 days of CABG surgery; explore the causes of readmissions; and investigate how patient- and hospital-level factors influence readmission. Methods We conducted systematic searches (until June 2020) of PubMed and Embase databases to retrieve observational studies that investigated readmission after CABG. Random effect meta-analysis was used to estimate rates and predictors of 30-day post-CABG readmission. Results In total, 53 studies meeting inclusion criteria were identified, including 8,937,457 CABG patients. The pooled 30-day readmission rate was 12.9% (95% CI: 11.3–14.4%). The most frequently reported underlying causes of 30-day readmissions were infection and sepsis (range: 6.9–28.6%), cardiac arrythmia (4.5–26.7%), congestive heart failure (5.8–15.7%), respiratory complications (1–20%) and pleural effusion (0.4–22.5%). Individual factors including age (OR per 10-year increase 1.12 [95% CI: 1.04–1.20]), female sex (OR 1.29 [1.25–1.34]), non-White race (OR 1.15 [1.10–1.21]), not having private insurance (OR 1.39 [1.27–1.51]) and various comorbidities were strongly associated with 30-day readmission rates, whereas associations with hospital factors including hospital CABG volume, surgeon CABG volume, hospital size, hospital quality and teaching status were inconsistent. Conclusions Nearly 1 in 8 CABG patients are readmitted within 30 days and the majority of these are readmitted for noncardiac causes. Readmission rates are strongly influenced by patients’ demographic and clinical characteristics, but not by broadly defined hospital characteristics.

Effects of Video-Based Patient Education and Consultation on Unplanned Health Care Utilization and Early Recovery After Coronary Artery Bypass Surgery (IMPROV-ED): Randomized Controlled Trial

“…The advantages of a shortened hospital stay might therefore be counterbalanced by preventable unplanned health care utilization, especially since planned care is not initiated until several weeks after discharge. At present, nearly 1 in 7 patients are readmitted in the first 30 days after discharge for noncardiac causes and roughly 15% of patients visit the emergency department within 1 month after CABG surgery [5][6][7][8]. It was estimated that potentially preventable readmissions following CABG surgery cost Medicare US $151 million in 2005, placing a significant burden on society [7].…”

Enhanced Telehealth Home-Monitoring Intervention for Vulnerable and Frail Patients after Cardiac Surgery (THE-FACS Pilot Intervention Study)

“…This was based on the available literature, and unpublished data from the NBHC, showing that frail patients have a higher risk of hospital readmission within 30 days of cardiac surgery [ 32 , 36 ]. It is generally reported that rates of readmission after cardiac surgery can range between 10–15% and are influenced largely by patient characteristics [ 37 ]. In the present pilot study, none of the patients who received THE-FACS intervention required readmission to the hospital.…”

The Association of Postoperative Anaemia with Outcomes in Cardiac Surgical Patients Eligible for Patient Blood Management: A Single Institution Retrospective Cohort Study

“…As with other acute illnesses, the postoperative period is a period of heightened vulnerability for patients, 32 particularly those with anaemia. As confirmed in this study, cardiac surgery exacerbates anaemia quite significantly postoperatively, 9,10,[33][34][35] causing haemoglobin levels to drop by an average of 30-40% and remain below 100 g/L for several weeks to months.…”