Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the Medicare population

Abstract

In a large cohort of Medicare patients undergoing coronary artery bypass grafting over 13 years, there was a significant decrease in 30-day readmission rates, a reduction in readmission for wound infections, and reduced mortality during the readmission episode, despite an increase in patient comorbidities. The improvement in readmission rates was seen regardless of patient variables examined.

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

“…In studies where history of comorbidities was reported, diabetes (range: 12 to 69%) and hypertension (range: 37 to 95%) were relatively common in patients undergoing CABG. While most studies included patients, who had either isolated or combined CABG procedures, 22 studies [ 8 , 13 , 26 , 29 , 31 , 33 , 35 – 37 , 39 , 40 , 45 – 48 , 50 , 51 , 54 , 56 , 58 , 59 , 62 ] included only those who underwent isolated CABG procedures. The included studies varied widely (range: 15 to 100%) in the proportion of elective procedures (Table 1 ).…”

“…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 ).…”

“…The estimated pooled OR for per 10-year increase in age from 11 studies [ 24 , 25 , 28 , 34 , 35 , 39 , 47 , 59 – 61 ] was 1.12 (1.04–1.20). Female sex (pooled OR from 20 studies [ 11 , 13 , 25 , 26 , 28 , 33 – 36 , 39 , 40 , 47 – 50 , 58 , 59 , 61 – 63 ]: 1.29 [1.25–1.34]) and non-White race (pooled OR from 12 studies [ 8 , 11 , 13 , 28 , 34 , 35 , 37 , 39 , 40 , 47 , 48 ]: 1.15 [1.10–1.21]) were associated with higher risk of readmissions within 30 days after CABG. Compared to those with private insurance, those with Medicare or Medicaid in the US were more likely to be readmitted (pooled OR from 11 studies [ 8 , 11 , 32 – 36 , 40 , 48 , 58 ]: 1.39 [1.27–1.51]) (Fig.…”

“…For meta-analyses for the associations of 12 comorbid conditions with readmission rate after CABG (Fig. 5 ), data came from 22 studies for diabetes [ 8 , 13 , 24 – 26 , 28 , 31 , 34 – 36 , 39 , 40 , 46 – 48 , 50 , 54 , 58 , 59 , 62 , 63 ], 11 studies for hypertension [ 8 , 13 , 35 , 36 , 47 , 48 , 54 , 59 , 62 , 63 ], 14 studies for heart failure [ 13 , 24 , 34 – 36 , 39 , 40 , 47 , 48 , 50 , 58 , 59 , 62 , 63 ], 12 studies for previous myocardial infarction (MI) [ 8 , 13 , 24 – 26 , 28 , 34 , 39 , 48 , 54 , 62 , 63 ], 6 studies for atrial fibrillation [ 8 , 13 , 26 , 36 , 47 , 48 ], 6 studies for stroke [ 13 , 40 , 47 , 50 , 54 , 59 ], 14 studies for peripheral vascular disease [ …”

“…For the associations of various hospital-level factors and 30-day readmission after CABG, we did not perform meta-analysis due to either differences in comparison groups or limited numbers of studies examining any specific association. A total of eight studies [ 8 , 13 , 20 , 22 , 23 , 30 , 35 , 48 ] examined the association with hospital CABG volume. Five studies [ 8 , 13 , 20 , 22 , 35 ] found that lower hospital CABG volume was significantly associated with higher rates of readmission while the other three studies [ 23 , 30 , 48 ] found no significant association (Table 2 ).…”