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Published on: July 18, 2014
Hospital readmissions in children with congenital heart disease: a population-based study
Andrew S Mackie1, Raluca Ionescu-Ittu, Louise Pilote
1McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), Montreal, Quebec, Canada.
Insights
About 15% of children with congenital heart disease (CHD) were readmitted within a month of discharge. Severe CHD, younger age, and weekend discharge increased readmission risk for pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Health Services Research
Background:
- Factors influencing readmission in children with congenital heart disease (CHD) are not well understood.
- Understanding readmission predictors is crucial for improving post-discharge care in pediatric CHD patients.
Purpose of the Study:
- To determine the rates and identify risk factors for hospital readmission within one month among children with CHD.
Main Methods:
- Utilized administrative data from Quebec hospitalizations (1990-2005) for children aged 0-17 with CHD.
- Employed Cox proportional hazards analysis to identify predictors of 30-day readmission following an index cardiac hospitalization.
Main Results:
- 15% (518/3675) of hospitalizations resulted in readmission within 31 days, with a median time of 12 days.
- Independent predictors of readmission included severe CHD, younger age, weekend discharge, recent ED visits, prolonged index hospitalization (>14 days), and multiple diagnoses.
- Invasive procedures during the index hospitalization were associated with a reduced likelihood of readmission.
Conclusions:
- Readmission affects approximately 1 in 7 pediatric hospitalizations for CHD.
- Infants and patients with severe CHD lesions face higher readmission risks.
- Avoiding weekend discharge may reduce readmission rates; targeted interventions for high-risk infants are warranted.
Background:
Little is known about the factors that predispose children with congenital heart disease (CHD) to readmission soon after hospital discharge. We sought to determine rates and risk factors for hospital readmission within 1 month among children with CHD.
Methods:
Data were obtained from administrative databases that record all hospitalizations within the province of Quebec. We included children 0 to 17 years with CHD who were hospitalized with a cardiac diagnosis (an "index hospitalization") between 1990 and 2005. Cox proportional hazards analysis was used to identify predictors of readmission.
Results:
Among 3675 hospitalizations, there were 518 readmissions (15%) within 31 days. Median time to readmission was 12 days (interquartile range 5-19 days). Readmissions occurred in the same hospital as the index hospitalization 86% of the time. The most common diagnoses at readmission were cardiac (59%) and respiratory illnesses (12%). Independent predictors of readmission were severe CHD lesion, younger age, Friday or Saturday discharge, having an emergency department visit within the preceding 6 months, length of index hospitalization > 14 days, and multiple (> or = 4) diagnoses (either cardiac diagnoses or comorbid conditions). Having an invasive procedure during the index hospitalization reduced the likelihood of readmission.
Conclusions:
Readmission occurred after 1 in 7 hospitalizations. Infants and patients with severe CHD lesions were among those more likely to be readmitted. The risk of readmission may be reduced by avoiding hospital discharge at the beginning of a weekend. Further studies are needed to determine if targeted interventions will reduce readmission rates in high-risk patients.
