Readmission after cardiac operations: Prevalence, patterns, and predisposing factors

D’Agostino, Richard S.; Jacobson, Jerilynn; Clarkson, Mindy; Svensson, Lars G.; Williamson, Christina; Shahian, David M.

doi:10.1016/s0022-5223(99)70051-6

Cited by 43 publications

(38 citation statements)

References 5 publications

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“…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). …”

Section: Role Of Diabetes Diagnosismentioning

confidence: 99%

The Effect of Diabetes on Hospital Readmissions

Dungan

2012

J Diabetes Sci Technol

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Abbreviations: (CHF) congestive heart failure, (DKA) diabetic ketoacidosis, (HbA1c) hemoglobin A1cKeywords: glycemic control, hemoglobin A1c, hospital, inpatient, readmission, rehospitalization AbstractHospital readmission is an important contributor to total medical expenditures and is an emerging indicator of quality of care. Diabetes, similar to other chronic medical conditions, is associated with increased risk of hospital readmission. Risk factors include previous hospitalization, extremes in age, and socioeconomic barriers. Preliminary studies suggest that acute and/or chronic glycemic control may be of importance when diabetes is the primary diagnosis or when it is a comorbidity. Very limited evidence from prospective randomized controlled trials aimed at improving glycemic control is available. However, whether one concludes that inpatient or outpatient glycemic control is partly responsible for reduced hospitalizations, attention to glycemic control in the hospital may facilitate sustained glycemic control post-discharge. Limited prospective and retrospective evidence suggest that the involvement of a diabetes specialist team may improve readmission rates, but attention to more generalized comprehensive approaches may also be worthwhile. Prospective interventional studies targeting interventions for improving glycemic control are needed to determine whether glycemic control impacts readmission rates.

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Section: Role Of Diabetes Diagnosismentioning

confidence: 99%

The Effect of Diabetes on Hospital Readmissions

Dungan

2012

J Diabetes Sci Technol

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“…Among published studies, [18][19][20] including the current report, half of all CABG readmissions are to hospitals other than where surgery was performed. This is substantially >20% to 40% average for all Medicare readmissions 16 and emphasizes the need to link clinical data with claims sources to ensure complete case ascertainment.…”

Section: Many Cabg Readmissions Go To Other Hospitalsmentioning

confidence: 99%

“…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.…”

Section: Improvement Opportunitiesmentioning

confidence: 99%

“…[20][21][22] This information may be helpful in identifying patients who may benefit from enhanced postdischarge follow-up.…”

Section: Improvement Opportunitiesmentioning

confidence: 99%

“…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.…”

Section: Improvement Opportunitiesmentioning

confidence: 99%

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

Shahian

O’Brien

et al. 2014

Circulation

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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.

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Higher Age Predicts Adverse Outcome and Readmission after Coronary Artery Bypass Grafting

et al. 2003

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The present prospective clinical study was carried out to investigate the effect of age on mortality, morbidity, and readmission rates after coronary artery bypass grafting (CABG). Data on 1131 consecutive CABG patients were collected in a surgical center and in all 18 secondary referral hospitals up to 3 months after discharge. Analysis was based on three age groups: 64 years or less (510 patients), 65 to 74 years (448 patients), and 75 years or more (173 patients). Thirty-day mortality rates were 1.6% for the youngest, 5.4% for the middle age group, and 6.9% for the oldest. Major complications occurred in 10.8%, 21.2%, and 24.9% of these patients, respectively. Higher age was associated with more readmissions to health care facilities: The oldest patients had a rate twice as high as those in the youngest group (34.5% vs. 18.6%). Atrial fibrillation (15.4%), chest pain (10.6%), and congestive heart failure (8.5%) were the most common reasons for readmission. In conclusion, elderly patients, who are often suboptimal candidates for CABG, have higher 30-day mortality, higher morbidity, longer length of stay in health care facilities, and an increased risk of readmission within 3 months after CABG; age was an independent predictor of 30-day mortality and postdischarge readmission. Despite the higher risk of adverse events after surgery, three out of four elderly patients recover uneventfully.

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Readmission after cardiac operations: Prevalence, patterns, and predisposing factors

Cited by 43 publications

References 5 publications

The Effect of Diabetes on Hospital Readmissions

The Effect of Diabetes on Hospital Readmissions

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

Higher Age Predicts Adverse Outcome and Readmission after Coronary Artery Bypass Grafting

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