Predicting 30-day readmission after congenital heart surgery across the lifespan

Abstract

Introduction: Hospital readmission is an important driver of costs among patients with CHD. We assessed predictors of 30-day rehospitalisation following cardiac surgery in CHD patients across the lifespan. Methods: This was a retrospective analysis of 981 patients with CHD who had cardiac surgery between January 2011 and December 2012. A multivariate logistic regression model was used to identify demographic, clinical, and surgical predictors of 30-day readmission. Receiver operating curves derived from multivariate logistic modelling were utilised to discriminate between patients who were readmitted and not-readmitted at 30 days. Model goodness of fit was assessed using the Hosmer–Lemeshow test statistic. Results: Readmission in the 30 days following congenital heart surgery is common (14.0%). Among 981 patients risk factors associated with increased odds of 30-day readmission after congenital heart surgery through multivariate analysis included a history of previous cardiac surgery (p < 0.001), longer post-operative length of stay (p < 0.001), as well as nutritional (p < 0.001), haematologic (p < 0.02), and endocrine (p = 0.04) co-morbidities. Patients who underwent septal defect repair had reduced odds of readmission (p < 0.001), as did children (p = 0.04) and adult (p = 0.005) patients relative to neonates. Conclusion: Risk factors for readmission include a history of cardiac surgery, longer length of stay, and co-morbid conditions. This information may serve to guide efforts to prevent readmission and inform resource allocation in the transition of care to the outpatient setting. This study also demonstrated the feasibility of linking a national subspecialty registry to a clinical and administrative data repository to follow longitudinal outcomes of interest.

Enhanced Safety and Efficiency of Ambulatory Cardiology Admissions: A Quality Improvement Initiative

“…0.69 approach resulted in a standardized handoff process and improved patient safety, especially in hemodynamically fragile patients with higher rates of hospital readmissions than other pediatric populations. [16][17][18] Use of I-PASS aligned with the hospital's handoff policies and previously established team handoff model. Interdisciplinary collaboration was essential across all Heart Center areas to understand the problem's scope and identify solutions.…”

“…8 This systematic approach resulted in a standardized handoff process and improved patient safety, especially in hemodynamically fragile patients with higher rates of hospital readmissions than other pediatric populations. 16–18 Use of I-PASS aligned with the hospital’s handoff policies and previously established team handoff model.…”