TY - JOUR
T1 - Etiologies and predictors of 30-day readmissions in patients undergoing percutaneous mechanical circulatory support–assisted percutaneous coronary intervention in the United States
T2 - Insights from the Nationwide Readmissions Database
AU - Bavishi, Chirag
AU - Lemor, Alejandro
AU - Trivedi, Vrinda
AU - Chatterjee, Saurav
AU - Moreno, Pedro
AU - Lasala, John
AU - Aronow, Herbert D.
AU - Dawn Abbott, J.
N1 - Funding Information:
The study cohort was derived from the Nationwide Readmission Database (NRD), a publicly available database of all-payer hospital inpatient stays developed by the Agency for Healthcare Research and Quality as part of the Healthcare Cost and Utilization Project. We used the NRD databases from 2012 to 2014. The NRD was constructed from 22 states with reliable, verified patient linkage numbers in the State Inpatient Databases that could be used to track the patient across hospitals within a state, while adhering to strict privacy guidelines. This database includes approximately 14 million patients, accounting for 51.2% of the total US resident population and 49.3% of all US hospitalizations. National estimates are obtained using sampling weights provided. Patients have a unique identifier that allows each patient to be tracked (the variable named “NRD_visitlink”). We determine the time between the first admission and the readmission by using the variable “NRD_daystoevent” and calculating the difference between that variable and the length of stay. A detailed explanation of all the variables in the NRD is available online (https:// www.hcup-us.ahrq.gov/nrdoverview.jsp).
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/4
Y1 - 2018/4
N2 - Background: Patients undergoing percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) represent a high-risk group vulnerable to complications and readmissions. Hypothesis: Thirty-day readmissions after pMCS-assisted PCI are common among patients with comorbidities and account for a significant amount of healthcare spending. Methods: Patients undergoing PCI and pMCS (Impella, TandemHeart, or intra-aortic balloon pump) for any indication between January 1, 2012, and November 30, 2014, were selected from the Nationwide Readmissions Database. Patients were identified using appropriate ICD-9-CM codes. Clinical risk factors and complications were analyzed for association with 30-day readmission. Results: Our analysis included 29 247 patients, of which 4535 (15.5%) were readmitted within 30 days. On multivariate analysis, age ≥ 65 years, female sex, hypertension, diabetes, chronic lung disease, heart failure, prior implantable cardioverter-defibrillator, liver disease, end-stage renal disease, and length of stay ≥5 days during index hospitalization were independent predictors of 30-day readmission. Cardiac etiologies accounted for ~60% of readmissions, of which systolic or diastolic heart failure (22%), stable coronary artery disease (11.1%), acute coronary syndromes (8.9%), and nonspecific chest pain (4.0%) were the most common causes. In noncardiac causes, sepsis/septic shock (4.6%), hypotension/syncope (3.2%), gastrointestinal bleed (3.1%), and acute kidney injury (2.6%) were among the most common causes of 30-day readmissions. Mean length of stay and cost of readmissions was 4 days and $16 191, respectively. Conclusions: Thirty-day readmissions after pMCS-assisted PCI are common and are predominantly associated with increased burden of comorbidities. Reducing readmissions for common cardiac etiologies could save substantial healthcare costs.
AB - Background: Patients undergoing percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) represent a high-risk group vulnerable to complications and readmissions. Hypothesis: Thirty-day readmissions after pMCS-assisted PCI are common among patients with comorbidities and account for a significant amount of healthcare spending. Methods: Patients undergoing PCI and pMCS (Impella, TandemHeart, or intra-aortic balloon pump) for any indication between January 1, 2012, and November 30, 2014, were selected from the Nationwide Readmissions Database. Patients were identified using appropriate ICD-9-CM codes. Clinical risk factors and complications were analyzed for association with 30-day readmission. Results: Our analysis included 29 247 patients, of which 4535 (15.5%) were readmitted within 30 days. On multivariate analysis, age ≥ 65 years, female sex, hypertension, diabetes, chronic lung disease, heart failure, prior implantable cardioverter-defibrillator, liver disease, end-stage renal disease, and length of stay ≥5 days during index hospitalization were independent predictors of 30-day readmission. Cardiac etiologies accounted for ~60% of readmissions, of which systolic or diastolic heart failure (22%), stable coronary artery disease (11.1%), acute coronary syndromes (8.9%), and nonspecific chest pain (4.0%) were the most common causes. In noncardiac causes, sepsis/septic shock (4.6%), hypotension/syncope (3.2%), gastrointestinal bleed (3.1%), and acute kidney injury (2.6%) were among the most common causes of 30-day readmissions. Mean length of stay and cost of readmissions was 4 days and $16 191, respectively. Conclusions: Thirty-day readmissions after pMCS-assisted PCI are common and are predominantly associated with increased burden of comorbidities. Reducing readmissions for common cardiac etiologies could save substantial healthcare costs.
KW - Cost
KW - Etiology
KW - Mechanical Circulatory Support
KW - Percutaneous Coronary Intervention
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=85046015696&partnerID=8YFLogxK
U2 - 10.1002/clc.22893
DO - 10.1002/clc.22893
M3 - Article
C2 - 29697866
AN - SCOPUS:85046015696
VL - 41
SP - 450
EP - 457
JO - Clinical Cardiology
JF - Clinical Cardiology
SN - 0160-9289
IS - 4
ER -