TY - JOUR
T1 - Wound complications and 30-day readmissions after single and bilateral internal mammary grafting
T2 - Analysis of the Nationwide Readmissions Database
AU - Hirji, Sameer
AU - Shah, Rohan
AU - Shah, Shawn
AU - Okoh, Alexis
AU - Seese, Laura
AU - Yazdchi, Farhang
AU - Aranki, Sary
AU - Shekar, Prem
AU - Kaneko, Tsuyoshi
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2021/1
Y1 - 2021/1
N2 - Background: This study compares the postoperative outcomes, 30-day readmission rates, and incidence of sternal wound infection-related readmissions between patients receiving bilateral internal mammary arteries (BIMA) and single internal mammary artery (SIMA) grafting during coronary artery bypass graft (CABG) surgery. Methods: We utilized the weighted 2013–2014 National Readmission Database claims to identify all US adult patients who underwent CABG utilizing SIMA (n = 279,891) or BIMA (n = 11,651). Thirty-day overall and wound-related readmissions, in-hospital outcomes, costs, lengths of stay (LOS) at readmissions were compared between the two groups. Predictors of 30-day readmission were assessed using multivariable Cox proportional hazards analysis. Results: After propensity matching (n = 10,339 pairs), there were no significant differences between the two groups during the index hospitalization, except for higher total hospital costs in the BIMA group (p =.02). The incidence of wound infections was also comparable between BIMA and SIMA (1.1% vs. 1.2%; p =.50). At 30-days, the overall readmission rate was elevated in SIMA patients (9.5% vs. 8.8%; p <.01), primarily impacted by cardiovascular causes. While the proportion of 30-day readmissions due to infections was significantly higher among BIMA versus SIMA patients (20.4% vs. 15.9%; p <.01), wound infections during the index hospitalization did not predict all-cause 30-day readmission among BIMA patients (p =.24) in the risk-adjusted analysis. Among the readmitted patients, LOS (6.4 vs. 6.2 days), costs ($14,440 vs. $16,461), and in-hospital mortality (2.4% vs. 1.7%) were comparable between the two groups (all p >.05). Conclusions: BIMA grafting is not an independent predictor of all-cause 30-day readmissions. Cardiovascular causes remain the primary driver of 30-day readmissions among SIMA and BIMA patients after CABG.
AB - Background: This study compares the postoperative outcomes, 30-day readmission rates, and incidence of sternal wound infection-related readmissions between patients receiving bilateral internal mammary arteries (BIMA) and single internal mammary artery (SIMA) grafting during coronary artery bypass graft (CABG) surgery. Methods: We utilized the weighted 2013–2014 National Readmission Database claims to identify all US adult patients who underwent CABG utilizing SIMA (n = 279,891) or BIMA (n = 11,651). Thirty-day overall and wound-related readmissions, in-hospital outcomes, costs, lengths of stay (LOS) at readmissions were compared between the two groups. Predictors of 30-day readmission were assessed using multivariable Cox proportional hazards analysis. Results: After propensity matching (n = 10,339 pairs), there were no significant differences between the two groups during the index hospitalization, except for higher total hospital costs in the BIMA group (p =.02). The incidence of wound infections was also comparable between BIMA and SIMA (1.1% vs. 1.2%; p =.50). At 30-days, the overall readmission rate was elevated in SIMA patients (9.5% vs. 8.8%; p <.01), primarily impacted by cardiovascular causes. While the proportion of 30-day readmissions due to infections was significantly higher among BIMA versus SIMA patients (20.4% vs. 15.9%; p <.01), wound infections during the index hospitalization did not predict all-cause 30-day readmission among BIMA patients (p =.24) in the risk-adjusted analysis. Among the readmitted patients, LOS (6.4 vs. 6.2 days), costs ($14,440 vs. $16,461), and in-hospital mortality (2.4% vs. 1.7%) were comparable between the two groups (all p >.05). Conclusions: BIMA grafting is not an independent predictor of all-cause 30-day readmissions. Cardiovascular causes remain the primary driver of 30-day readmissions among SIMA and BIMA patients after CABG.
KW - coronary artery bypass grafting
KW - readmissions
KW - wound complications
UR - http://www.scopus.com/inward/record.url?scp=85094682274&partnerID=8YFLogxK
U2 - 10.1111/jocs.15161
DO - 10.1111/jocs.15161
M3 - Article
C2 - 33135295
AN - SCOPUS:85094682274
SN - 0886-0440
VL - 36
SP - 74
EP - 81
JO - Journal of cardiac surgery
JF - Journal of cardiac surgery
IS - 1
ER -