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Published on: March 27, 2018
Incidence, Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting
Rohan M Shah1, Qianzi Zhang1, Subhasis Chatterjee1
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Thirty-day readmissions after coronary artery bypass grafting (CABG) are common. Key predictors include Medicaid status, longer hospital stays, and discharge to a skilled nursing facility, highlighting areas for targeted interventions.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- Hospital readmissions negatively impact reimbursement and quality metrics.
- Coronary artery bypass grafting (CABG) is a major surgical procedure with significant readmission rates.
Purpose of the Study:
- To evaluate the incidence, cost, and risk factors associated with 30-day readmissions after CABG.
- Identify key predictors for readmission to inform targeted interventions.
Main Methods:
- Utilized the National Readmissions Database (NRD) for patients undergoing isolated CABG between 2013-2014.
- Compared demographics, comorbidities, in-hospital outcomes, and costs between readmitted and non-readmitted patients.
- Employed generalized linear regression to determine independent predictors of readmission.
Main Results:
- Identified 288,059 isolated CABG patients; 12.2% experienced 30-day readmission.
- Top readmission reasons included postoperative infection, heart failure, and arrhythmia.
- Significant predictors for readmission were Medicaid status, female sex, renal failure, multiple comorbidities, COPD, nonelective surgery, prolonged length of stay (LOS), acute kidney injury, atrial fibrillation, pneumonia, and discharge to a skilled nursing facility.
Conclusions:
- Thirty-day readmissions post-CABG are frequent, driven by preoperative comorbidities and complex postoperative care.
- Medicaid status, extended LOS, and skilled nursing facility discharge are strong predictors of readmission.
- Interventions should focus on improving care for high-risk patient cohorts to reduce readmissions.
Background:
Readmissions adversely affect hospital reimbursement and quality measures. We aimed to evaluate the incidence, cost, and risk factors for readmission following coronary artery bypass grafting (CABG).
Methods:
We queried the National Readmissions Database and isolated patients who underwent CABG from 2013 to 2014. We determined the top reasons for readmission and compared demographics, comorbidities, in-hospital outcomes, and costs between readmitted and nonreadmitted patients. Generalized linear regression was performed to identify independent predictors for readmission.
Results:
We identified 288,059 patients who underwent isolated CABG in the United States between 2013 and 2014. A total of 12.2% were readmitted within 30 days of discharge. Postoperative infection, heart failure, and arrhythmia were the most common reasons for readmission. The median time to readmit was 11 days, with a length of stay (LOS) of 6 days and a cost of $13,499 ± $201. Independent preoperative predictors for readmission were Medicaid status (odds ratio [OR], 1.33), female sex (OR, 1.32), chronic renal failure (OR, 1.26), greater than 4 Elixhauser comorbidities (OR, 1.20), chronic pulmonary disease (OR, 1.15), and nonelective operation (OR, 1.10) (all p < 0.05). In-hospital predictors included LOS greater than 10 days (OR, 1.52), acute kidney injury (OR, 1.30), atrial fibrillation (OR, 1.20), pneumonia (OR, 1.13), and discharge to skilled nursing facility (OR, 1.43) (all p < 0.05).
Conclusions:
Thirty-day readmissions after CABG are frequent and related to preoperative comorbidities and complex postoperative course. Medicaid status, prolonged LOS, and disposition to a skilled nursing facility are strong predictors for 30-day readmission following CABG. Readmission reduction efforts should consider improvements for patients in these cohorts.
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