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A Clinical Risk Scoring Tool to Predict Readmission After Cardiac Surgery: An Ontario Administrative and Clinical
Derrick Y Tam1, Jiming Fang2, Andrew Tran3
1Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Insights
Reducing readmissions after cardiac surgery is crucial. A new risk score identifies patients needing closer monitoring, with factors like prolonged hospital stay and valve surgery increasing risk.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Predictive Analytics
Background:
- Reducing hospital readmissions post-cardiac surgery is a key quality improvement goal.
- Existing risk models often focus narrowly on coronary artery bypass grafting (CABG) surgery.
- A comprehensive risk assessment tool for diverse cardiac surgical procedures is needed.
Purpose of the Study:
- To develop and validate a predictive risk score for 30-day readmission after various cardiac surgeries.
- To identify significant risk factors associated with readmission in a large patient cohort.
- To create a clinical tool for stratifying patient risk and guiding post-discharge care.
Main Methods:
- Retrospective analysis of adult patients undergoing isolated CABG, valve surgery, or combined procedures (2008-2016) in Ontario.
- Utilized linked administrative health databases to identify risk factors for 30-day readmission.
- Developed a clinical risk score using Cox proportional hazards regression and validated its predictive performance.
Main Results:
- The study included 63,336 patients, with an overall 30-day readmission rate of 11.5%.
- Key predictors of readmission included prolonged length of stay, isolated valve surgery, in-hospital sepsis, and acute myocardial infarction.
- A 22-variable risk score was derived, categorizing patients into five risk quintiles (c-statistic = 0.63).
Conclusions:
- Readmission following cardiac surgery is a common occurrence.
- The developed risk score demonstrates moderate predictability in a contemporary patient population.
- This tool can aid in identifying high-risk patients for targeted interventions to reduce readmissions.
Background:
Reducing readmission after cardiac surgery remains a quality improvement priority yet most readmission risk models examine only coronary artery bypass grafting (CABG). Our objective was to develop a predictive risk score for readmission after discharge in cardiac surgery.
Methods:
All adults > 18 years undergoing isolated CABG, isolated/multiple valve, or combined CABG/valve surgery from 2008 to 2016 in Ontario were eligible. Risk factors for 30-day readmission after discharge were obtained through linkages of the CorHealth Ontario Cardiac Registry to other administrative health databases. Hazard ratios (HR) for risk factors were calculated using Cox proportional hazards regression with 95% confidence intervals (95% CI). We developed a clinical risk scoring tool weighted by beta coefficients from the final model. Discrimination and calibration was performed using c-statistics and comparing the predicted with observed probabilities across deciles of predicted risk.
Results:
A total of 63,336 patients underwent CABG and/or valve surgery from 2008 to 2016. The 30-day readmission rate was 11.5% overall. Patients who were readmitted were older with higher incidences of cardiac comorbidities compared with nonreadmitted patients. Significant risk factors for readmission from the final model were prolonged length of stay (HR: 1.45; 95% CI: 1.57, 1.86; P < 0.0001), isolated valve surgery (HR: 1.35; 95% CI: 1.26, 1.44; P < 0.0001), in-hospital complications of sepsis (HR: 1.47; 95% CI: 1.05, 2.07; P = 0.024), and acute myocardial infarction (HR: 1.36; 95% CI: 1.09, 1.71; P = 0.007). A clinical risk scoring tool with 22 variables was derived that delineated patients into 1 of 5 risk quintiles. The c-statistic for the overall model was 0.63.
Conclusions:
Readmission after cardiac surgery is common and moderately predictable in this contemporary cohort.
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