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Published on: March 27, 2018
30-day readmissions after coronary artery bypass graft surgery in New York State
Edward L Hannan1, Ye Zhong, Stephen J Lahey
1University at Albany, State University of New York, Albany 12144-3456, USA. elh03@health.state.ny.us
Insights
High 30-day readmission rates persist after coronary artery bypass graft (CABG) surgery, driven by infections and heart failure. Identifying patient risk factors is crucial for monitoring and improving quality of care.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Patient Outcomes
Background:
- Short-term readmissions significantly increase healthcare costs.
- Coronary artery bypass graft (CABG) surgery is a high-cost medical procedure.
- Understanding readmission drivers is vital for cost containment and quality improvement.
Purpose of the Study:
- To identify the primary reasons for 30-day readmissions following CABG surgery.
- To determine significant predictors associated with CABG patient readmissions.
- To evaluate the relationship between hospital readmission rates and mortality rates as quality indicators.
Main Methods:
- Retrospective analysis of 30-day readmissions for 33,936 CABG patients in New York State (2005-2007).
- Identification of principal diagnoses for readmission and significant independent predictors.
- Exploration of the correlation between risk-adjusted mortality and readmission rates across hospitals.
Main Results:
- Common readmission reasons included post-operative infection (16.9%), heart failure (12.8%), and surgical/medical complications (9.8%).
- Predictors of readmission included advanced age, female sex, African-American race, obesity, comorbidities, post-operative renal failure/reoperation, Medicare/Medicaid status, skilled nursing facility discharge, saphenous vein grafts, and longer hospital stays.
- A moderate correlation (0.32, p=0.047) was found between hospital risk-adjusted readmission and mortality rates; readmission rates varied from 8.3% to 21.1% across hospitals.
Conclusions:
- The 30-day readmission rate for CABG surgery remains high, despite declining mortality.
- Close patient monitoring is recommended for individuals with identified risk factors for readmission.
- Hospital readmission rates may serve as an independent quality measure, as they are not strongly correlated with mortality rates.
Objectives:
The aim of this study was to identify reasons for and predictors of readmission.
Background:
Short-term readmissions have been identified as an important cause of escalating health care costs, and coronary artery bypass graft (CABG) surgery is 1 of the most expensive procedures.
Methods:
We retrospectively analyzed 30-day readmissions for 33,936 New York State patients who underwent CABG surgery between January 1, 2005, and November 30, 2007. The main reasons for readmission (principal diagnoses) and the significant independent predictors of readmission were identified. The hospital-level relationship between risk-adjusted mortality rate and risk-adjusted readmission rate was explored to determine the value of readmission rate as a complementary measure of quality.
Results:
The most common reasons for readmission were post-operative infection (16.9%), heart failure (12.8%), and "other complications of surgical and medical care" (9.8%). Increasing age, female sex, African-American race, higher body mass index, numerous comorbidities, 2 post-operative complications (renal failure and unplanned cardiac reoperation), Medicare or Medicaid status, discharges to a skilled nursing facility, saphenous vein grafts, and longer lengths of stay were all associated with higher rates of readmission. The correlation between the risk-adjusted 30-day readmission rate of hospitals and risk-adjusted in-hospital/30-day mortality rate was 0.32 (p = 0.047). The range across hospitals in the readmission rate was from 8.3% to 21.1%.
Conclusions:
The 30-day readmission rate for CABG surgery remains high, despite decreases in short-term mortality. Patients with any of the numerous risk factors for readmission should be closely monitored. Hospital readmission rates are not highly correlated with mortality rates and might serve as an independent quality measure.
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