Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Abstract

Background Readmissions are a common problem in cardiac surgery. The goal of this study was to examine the frequency, timing, and associated risk factors for readmission after cardiac surgery. Methods 5,158 adult cardiac surgery patients (5,059 included in analysis) were prospectively enrolled in a 10center cohort study to assess risk factors for infection following cardiac surgery. Data were also collected on all-cause readmissions occurring within 65 days after surgery. Major outcomes included readmission rate stratified by procedure type, cause of readmission, length of readmission stay, and discharge disposition after readmission. Multivariable Cox regression was used to determine risk factors for time to first readmission. Results The overall rate of readmission was 18.7% (number of readmissions=945). When stratified by the most common procedure type, readmission rates were: isolated CABG (14.9%, n=248), isolated valve (18.3%, n=337), CABG + valve (25.0%, n=169). The three most common causes of first readmission within 30 days were: infection (17.1%, n=115), arrhythmia (17.1%, n=115), and volume overload (13.5%, n=91). More first readmissions occurred within 30 days (80.6%, n=672) than after 30 days (19.4%, n=162), and 50% of patients were readmitted within 22 days from index surgery. The median length of stay during the first readmission was 5 days. 15.8% (n=128) of readmitted patients were discharged to a location other than home. Baseline patient characteristics associated with readmission included: female gender, diabetes mellitus on medication, COPD, elevated creatinine, lower hemoglobin, and longer surgery time. In addition, the more complex surgical procedures were associated with increased risk of readmission compared to the CABG group. Conclusions Nearly 1 out of 5 patients who undergo cardiac surgery require readmission, an outcome with significant health and economic implications. Management practices to avert in-hospital infections, reduce post-operative arrhythmias, and avoid volume overload offer important targets for quality improvement.

Early Rehospitalization After Prolonged Intensive Care Unit Stay Post Cardiac Surgery: Outcomes and Modifiable Risk Factors

“…Our 30‐day rehospitalization rate for a mixture of cardiac surgery operations for the entire patient population (not just prICULOS patients) postdischarge was 11.7%. This is in keeping with the published literature, which generally consists of large studies (thousands of patients) from multiple hospitals in the United States where 30‐day rehospitalization rates (mostly post CABG) average about 5% to 12% with the range being 0% to 80% . Our 90‐day rehospitalization rate of 17.2% (Figure ) is also comparable to the published results from Iribarne et al, who reported 65‐day rehospitalization rates (from index operation) among 10 centers with 5158 adult cardiac surgical patients at 18.7%.…”

Sleep apnoea and unscheduled re-admission in patients undergoing coronary artery bypass surgery

“…Nevertheless, unscheduled re-admissions after hospital discharge remain a persistent clinical challenge. The 30-day re-admission rate after CABG is 15e20%, and is an important cause of prolonging recovery, patient dissatisfaction and escalating medical costs [18,27,28]. To our knowledge, this is the first study to evaluate the effects of sleep apnoea on unscheduled re-admissions after CABG.…”

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

“…To our knowledge, the only prospective multi‐center study of chart‐level data with respect to causes of readmission after cardiac surgery comes from The Cardiothoracic Surgical Trials Network, which examined all‐cause readmissions occurring within 65 days of cardiac surgery for 5158 adults across 10 centers . The overall rate of readmission was 18.7% and the primary causes of admission were infection (17.1%), arrhythmia (17.1%), and volume overload (13.5%).…”