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

Abstract

Background— Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higher-than-expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data. Methods and Results— We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008–2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records. Among 265 434 eligible Medicare records, 226 960 (86%) were successfully linked to Society of Thoracic Surgeons records; 162 572 (61%) isolated coronary artery bypass grafting admissions constituted the study cohort. Logistic regression was used to identify readmission risk factors; hierarchical regression models were then estimated. Risk-standardized readmission rates ranged from 12.6% to 23.6% (median, 16.8%) among 846 US hospitals with ≥30 eligible cases and ≥90% of eligible Centers for Medicare and Medicaid Services records linked to the Society of Thoracic Surgeons database. Readmission predictors (odds ratios [95% confidence interval]) included dialysis (2.02 [1.87–2.19]), severe chronic lung disease (1.58 [1.49–1.68]), creatinine (2.5 versus 1.0 or lower:1.49 [1.41–1.57]; 2.0 versus 1.0 or lower: 1.37 [1.32–1.43]), insulin-dependent diabetes mellitus (1.45 [1.39–1.51]), obesity in women (body surface area 2.2 versus 1.8: 1.44 [1.35–1.53]), female sex (1.38 [1.33–1.43]), immunosuppression (1.38 [1.28–1.49]), preoperative atrial fibrillation (1.36 [1.30–1.42]), age per 10-year increase (1.36 [1.33–1.39]), recent myocardial infarction (1.24 [1.08–1.42]), and low body surface area in men (1.22 [1.14–1.30]). C-statistic was 0.648. Fifty-two hospitals (6.1%) had readmission rates statistically better or worse than expected. Conclusions— A coronary artery bypass grafting surgery readmission measure suitable for public reporting was developed by using the national Society of Thoracic Surgeons clinical data linked to Medicare readmission claims.

Acute Kidney Injury Severity and Long-Term Readmission and Mortality After Cardiac Surgery

“…In addition, we adjusted for variables used in the age, sex, body surface area, and vascular disease in our models. (21)…”

Effect of statin therapy on cardiovascular outcomes after coronary revascularization in patients ≥80 years of age: Observations from the CREDO-Kyoto Registry Cohort-2

“…In the CathPCI Registry for coronary angiography and percutaneous coronary intervention (PCI) enrolled in the United States in 2011, 12.2% of patients were !80 years of age [9]. In the STS-ACSD (the Society of Thoracic Surgeons Adult Cardiac Surgery Database), 17.2% of patients undergoing isolated Coronary Artery Bypass Grafting (CABG) from 2008 to 2010 were !80 years of age [10]. Given the progressive aging of the patients undergoing coronary revascularization and the fact that coronary artery disease is the main cause of death among elderly, it is crucially important to elucidate the effects of statin therapy on cardiovascular outcomes after coronary revascularization in elderly patients !80 years of age.…”

Need of informatics in designing interoperable clinical registries

“…Shahian et al (23) developed a clinical registry to study readmission measure for coronary artery bypass grafting surgery. McCombs et al (24) studied and analyzed data from a department of veterans affairs clinical registry to evaluate the risk of long-term morbidity in patients with chronic hepatitis C. Sites et al (25) illustrated the use of international clinical registry in quality improvement.…”