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

Abstract

Background Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value‐oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. Methods Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients’ medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. Results Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4‐16 days) and only 13% of patients were evaluated in‐office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. Conclusions Ensuring early follow‐up for high‐risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.

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

“…Characteristics of all 53 studies [ 7 , 8 , 11 – 14 , 20 – 66 ] included in this systematic review are given in Table 1 . Forty studies [ 7 , 8 , 11 – 14 , 20 – 26 , 28 – 37 , 39 – 44 , 46 – 49 , 52 , 54 , 58 , 59 , 62 , 64 , 65 ] (75% of all included studies) were from the USA. Most studies [ 7 , 8 , 11 – 14 , 20 , 21 , 25 , 27 , 32 , 33 , 35 – 37 , 39 – 42 , 44 , 46 – 49 , 52 , 58 , 59 , 61 , 63 , 65 , 66 ] ( n = 31) were based on administrative data aggregated across multiple sites and 22 studies [ 22 – 24 , 26 , 28 – 31 , 34 , 38 , 43 , 45 , 50 , 51 , 53 – 57 , 60 , 62 , 64 ] used medical records from either a single center or multiple...…”

“…Twenty-three studies [ 8 , 13 , 28 , 31 , 35 , 36 , 39 – 41 , 43 , 46 , 48 , 50 , 52 , 54 , 55 , 57 , 58 , 60 , 62 – 64 , 66 ] reported the causes of 30-day readmission after CABG (Fig. 4 ).…”

Outcomes of 3‐day discharge after elective cardiac surgery

“…Our institutional 30‐day readmission rate (7%) falls on the lower range of other contemporary reports on readmission after elective cardiac surgery, which range from 11% to 19% 17–20 . The most common reason for readmission in our cohort was arrhythmia or heart block; while arrhythmia is a common reason for readmission in all other reports, more report infection (typically defined as cumulative variable of pneumonia, skin, soft tissue, or deep sternal infections) as the most common reason for readmission 18–20 .…”

Use of minimally invasive surgery and therapies mitigating pulmonary arterial pressure and intraoperative blood loss may offer protection against cardiac surgery-associated acute kidney injury

“…RBC transfusion, however, has also been associated with increased morbidity and mortality, presumably due to infectious and non-infectious risks [40,41]. Therefore, it is plausible that, by decreasing the incidence of blood transfusions and bleeding complications (e.g., with minimally invasive valve surgery), CSA-AKI and its associated complications may be reduced.…”