Risk factors for early hospital readmission after cardiac operations

Abstract

The high-risk patient for readmission is a woman with diabetes, chronic lung disease, renal insufficiency, and preoperative atrial fibrillation who lives at a distance from the hospital. Readmission does not depend on periprocedural variables (eg, cardiopulmonary bypass time) or on postoperative complications. High procedural costs from the initial hospitalization do not predispose to readmission. These results suggest interventions that may reduce readmission.

The Effect of Diabetes on Hospital Readmissions

“…18 In patients with diabetes, comorbidities that were predictors of readmission following hospitalization on internal medicine services at a single center include a history of CHF, renal dysfunction, anemia, and atrial fibrillation. 20 As a comorbidity itself, diabetes is associated with increased readmission following hospitalization for CHF, 21,22 renal transplant, 23 cardiac surgery, [24][25][26] and coronary artery bypass surgery with preexisting left ventricular dysfunction 27 ( Table 2). …”

Once A Cure; Second A Waste: Examining Hospital Readmission Rates of the Commercially Insured Under 65 Population

“…Kansagara et al (2011) in their systematic review of readmission risk prediction models reported that the majority of studies to date were limited to either the Medicare population and/or the VA covered population and found none that used data for commercially insured populations. Some studies focused on a single specific disease condition (Ohman et al (2000) , Almagro et al (2006), Carneiro et al (2010) , Ferraris et al (2001) Garcia et al (2003, Koehler et al (2009) and Bottle et al (2006), while other studies used data covering only a single site and/or hospital sample (Iloabuchi et al 2014). In general, these studies contribute to our understanding of a range of risk factors, but their lack of generalizability to a broad range of conditions may render them inapplicable to assessing performance in the commercially insured population under age 65.…”

Development of a Clinical Registry-Based 30-Day Readmission Measure for Coronary Artery Bypass Grafting Surgery

“…Numerous studies 11,[18][19][20][21][22][24][25][26] have examined the causes and predictors of readmission after cardiac surgery, including CABG. Common reasons for readmission include wound infections; heart failure; arrhythmias; indeterminate chest pain, myocardial infarction, or angina; pneumonia or pleural effusions; stroke; sepsis; gastrointestinal complications; and renal failure.…”

“…Finally, although not traditionally considered appropriate for inclusion in profiling risk models, several studies 11,[20][21][22]26 have identified sociodemographic and hospital factors that are associated with readmission risk including low household income, discharge to a venue other than home, distance from hospital to home, low surgeon volume, and high risk-adjusted hospital mortality rates.…”

“…Better inpatient care, more complete predischarge resolution of certain problems, more effective care transitions to the community environment, and closer postoperative follow-up may be useful in reducing readmissions. 26,27 Specific clinical interventions might include optimization of diabetes mellitus control; reduction of wound infections (antibiotic timing and selection, meticulous surgical technique); prevention of early graft closure (enhanced use of arterial grafts, consistent use of postoperative aspirin); minimizing pulmonary complications (early ambulation and pulmonary rehabilitation; predischarge thoracentesis or early follow-up chest x-ray and return visit for pleural effusions); more aggressive prophylaxis and treatment of perioperative atrial fibrillation; guidelinedirected use of medications such as β-blockade, statins, aspirin, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; and daily postdischarge monitoring of patient weights to assess fluid retention and the need for diuresis.…”