TY - JOUR
T1 - Thirty-Day Nonindex Readmissions and Clinical Outcomes After Cardiac Surgery
AU - Hirji, Sameer A.
AU - Percy, Edward D.
AU - Zogg, Cheryl K.
AU - Vaduganathan, Muthiah
AU - Kiehm, Spencer
AU - Pelletier, Marc
AU - Kaneko, Tsuyoshi
N1 - Funding Information:
Dr Zogg is supported by NIH Medical Scientist Training Program Training Grant T32GM007205. Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health/National Center for Advancing Translational Sciences Award UL 1TR002541) and participates on clinical end point committees for studies sponsored by Novartis and the National Institutes of Health. Dr Kaneko is a speaker for Edwards Life Sciences, Medtronic, Abbott and Baylis Medical and is a consultant for 4C Medical.
Funding Information:
Dr Zogg is supported by NIH Medical Scientist Training Program Training Grant T32GM007205. Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst ( National Institutes of Health / National Center for Advancing Translational Sciences Award UL 1TR002541 ) and participates on clinical end point committees for studies sponsored by Novartis and the National Institutes of Health . Dr Kaneko is a speaker for Edwards Life Sciences, Medtronic, Abbott and Baylis Medical and is a consultant for 4C Medical.
Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/8
Y1 - 2020/8
N2 - Background: With increasing emphasis on readmissions as an important quality metric, there is an interest in regionalization of care to high-volume centers. As a result, care of readmitted cardiac surgery patients may be fragmented if readmission occurs at a nonindex hospital. This study characterizes the frequency, risk factors, and outcomes of nonindex hospital readmission after cardiac surgery. Methods: In this multicenter, population-based, nationally representative sample, we used weighted 2010-2015 National Readmission Database claims to identify all US adult patients who underwent 2 of the major cardiac surgeries, isolated coronary artery bypass grafting (CABG) or isolated surgical aortic valve replacement (SAVR), during their initial hospitalization. We examined characteristics, predictors, and outcomes after nonindex readmission. Results: Overall, 1,070,073 procedures were included (844,206 CABG and 225,866 SAVR). Readmission at 30 days was 12.8% for CABG and 14.5% for SAVR. Nonindex readmissions accounted for 23% and 26% at 30 days; these were primarily noncardiac in etiology. The proportion of nonindex readmissions did not change significantly from 2010 to 2015. For CABG and SAVR, in-hospital mortality (adjusted odds ratios of 1.26 and 1.37, respectively) and major complications (odds ratios of 1.17 and 1.25, respectively) were significantly higher during nonindex versus index readmission, even after adjusting for patient risk profile, case mix, and hospital characteristics. Older age, higher income, and increased comorbidity burden were all independent predictors of nonindex readmission. Conclusions: A considerable proportion of patients readmitted after cardiac surgery are readmitted to nonindex hospitals. This fragmentation of care may account for worse outcomes associated with nonindex readmissions in this complex population.
AB - Background: With increasing emphasis on readmissions as an important quality metric, there is an interest in regionalization of care to high-volume centers. As a result, care of readmitted cardiac surgery patients may be fragmented if readmission occurs at a nonindex hospital. This study characterizes the frequency, risk factors, and outcomes of nonindex hospital readmission after cardiac surgery. Methods: In this multicenter, population-based, nationally representative sample, we used weighted 2010-2015 National Readmission Database claims to identify all US adult patients who underwent 2 of the major cardiac surgeries, isolated coronary artery bypass grafting (CABG) or isolated surgical aortic valve replacement (SAVR), during their initial hospitalization. We examined characteristics, predictors, and outcomes after nonindex readmission. Results: Overall, 1,070,073 procedures were included (844,206 CABG and 225,866 SAVR). Readmission at 30 days was 12.8% for CABG and 14.5% for SAVR. Nonindex readmissions accounted for 23% and 26% at 30 days; these were primarily noncardiac in etiology. The proportion of nonindex readmissions did not change significantly from 2010 to 2015. For CABG and SAVR, in-hospital mortality (adjusted odds ratios of 1.26 and 1.37, respectively) and major complications (odds ratios of 1.17 and 1.25, respectively) were significantly higher during nonindex versus index readmission, even after adjusting for patient risk profile, case mix, and hospital characteristics. Older age, higher income, and increased comorbidity burden were all independent predictors of nonindex readmission. Conclusions: A considerable proportion of patients readmitted after cardiac surgery are readmitted to nonindex hospitals. This fragmentation of care may account for worse outcomes associated with nonindex readmissions in this complex population.
UR - http://www.scopus.com/inward/record.url?scp=85081016020&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.11.042
DO - 10.1016/j.athoracsur.2019.11.042
M3 - Article
C2 - 31972128
AN - SCOPUS:85081016020
SN - 0003-4975
VL - 110
SP - 484
EP - 491
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -