Prediction of Readmissions After CABG Using Detailed Follow-Up Data

Zitser-Gurevich, Yana; Simchen, Elisheva; Galai, Noya; Braun, Dalit

doi:10.1097/00005650-199907000-00002

Cited by 36 publications

(33 citation statements)

References 19 publications

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“…Earlier studies have also found that elderly persons (2,3,9,10), women (2,3,9 -12), and African Americans (2,3) were more likely to experience readmissions; in addition to these factors, our earlier study also found that congestive heart failure, COPD, diabetes, and longer lengths of stay were independently associated with higher readmission rates (2). Another study found that longer lengths of stay in the index admission were associated with higher readmission rates (13).…”

Section: Discussionmentioning

confidence: 52%

30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

Hannan

Lahey

et al. 2011

JACC: Cardiovascular Interventions

215

173

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Section: Discussionmentioning

confidence: 52%

30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

Hannan

Lahey

et al. 2011

JACC: Cardiovascular Interventions

215

173

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“…18 Smaller studies have found much higher 30-day to 2-year all-cause readmission rates for females; however, this was attributed in part to a higher occurrence of surgical wound infections. 13,16,31,32 In contrast, in Sweden, a study with 1588 female patients found no gender difference in all-cause readmission rates with multivariable adjustment. 17 The pres- …”

Section: Discussionmentioning

confidence: 88%

Gender Differences in Outcomes After Hospital Discharge From Coronary Artery Bypass Grafting

et al. 2006

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Background-There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting (CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results-A population-based cohort study (nϭ68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission (angina, heart failure, myocardial infarction), repeat revascularization (angioplasty or CABG), and stroke readmission between men and women. Women were older (65Ϯ17 versus 62Ϯ13 years), more likely to present with urgent or emergent status (64% versus 56%), and less likely to receive arterial grafts (70% versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery (hazard ratio [HR] of 1.5, 95% confidence interval [CI] 1.36 to 1.56), and this increased risk persisted after 1 year (HR 1.2, 95% CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina (HR 1.3, 95% CI 1.24 to 1.38) and congestive heart failure (HR 1.1, 95% CI 1.06 to 1.21). Propensity-matched women had similar rates of death (HR 0.9, 95% CI 0.83 to 0.98) and repeat revascularization (HR 1.0, 95% CI 0.91 to 1.06). Conclusions-Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women. (Circulation. 2006;113:507-516.)

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“…14,[16][17][18][19]47 In fact, a significantly greater proportion of women than men are readmitted to hospital after CABG. 14,[17][18][19]47,48 Overall, the rate of readmissions have been reported to range between 12.9% and 16.5% within 30 days after surgery, [16][17][18][19] 24.1% within 3 months, 48 24.3% within 6 months, 14 and, among Medicare beneficiaries, 42% within 1 year of CABG surgery 15 and thus could affect both referral and CR wait times. Clearly, medical reasons for delayed entry are appropriate (however, it is arguable they could be mitigated by early follow-up in CR), and interventions are needed to focus on nonmedical reasons for delayed entry.…”

Section: Correlates Of Longer Wait Timesmentioning

confidence: 99%

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Marzolini

Blanchard

Alter

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-Cardiac rehabilitation (CR) is recommended after coronary artery bypass graft surgery; however, the consequences of longer wait times to start CR have not been elucidated. Method and Results-Cardiopulmonary, demographic, and anthropometric assessments were conducted before and after 6 months of CR in consecutively enrolled patients from January 1995 to October 2012. Wait times were ascertained from referral forms and charts. Neighborhood characteristics were ascertained using census data and cross-referencing with patients' home geographic location. Among 6497 post-coronary artery bypass graft participants, mean and median total wait time (time from surgery to first exercise session) was 101.1±47.9 and 80 days, respectively. In multiple linear regression, correlates of longer total wait time and the 2 wait-time phases, time from surgery to CR referral and time from CR referral to first exercise session, were determined. Factors influencing longer wait times included female sex, greater age, being employed, less social support, longer drive time to CR, lower neighborhood socioeconomic status, higher systolic blood pressure, abdominal obesity, and a complex medical history. After adjusting for correlates of delayed entry, longer wait time for each of the total and 2 wait-time phases was significantly associated with less improvement in cardiopulmonary fitness (VO 2peak ; β=−0.165, P<0.001), body fat percentage (β=0.032, P<0.02), resting heart rate (β=0.066, P<0.001), and poorer attendance to CR classes (β=−0.081, P<0.001) and completion rate (β=2.741, P<0.001). Conclusions-Strategies for timely access to CR at each phase of the process are important given the negative impact that wait time has on key clinical outcomes. This is relevant because optimizing VO 2peak and attendance to CR has been shown to confer a mortality advantage. (Circ Cardiovasc Qual Outcomes. 2015;8:608-620.

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Prediction of Readmissions After CABG Using Detailed Follow-Up Data

Cited by 36 publications

References 19 publications

30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

Gender Differences in Outcomes After Hospital Discharge From Coronary Artery Bypass Grafting

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

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