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Outcomes and readmissions after cardiac surgery in patients with chronic steroid use: a nationwide propensity score
Jean-Luc A Maigrot1, Guangjin Zhou2, Siran M Koroukian2
1Department of Thoracic & Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, 44915, OH, USA.
Insights
Patients using chronic steroids (CSU) undergoing cardiac surgery had similar outcomes during initial hospital stays but higher 30-day readmission rates. Readmission complications were comparable between CSU and non-CSU patients.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Pharmacology
Background:
- Chronic steroid use (CSU) is associated with increased comorbidities.
- Evaluating outcomes after cardiac surgery in CSU patients is crucial.
Purpose of the Study:
- To compare index admission outcomes and 30-day readmissions in cardiac surgery patients with and without chronic steroid use (CSU).
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2020) for cardiac surgery patients.
- Stratified patients by CSU diagnosis and employed propensity score matching (PSM) for comparison.
- Analyzed in-hospital mortality, complications, and 30-day readmission rates.
Main Results:
- Identified 12,082 CSU patients among 1,332,806 cardiac surgery patients.
- Post-PSM, no significant differences in index admission mortality or complications were observed.
- CSU patients exhibited higher 30-day readmission rates (16% vs. 13%, P < .01).
Conclusions:
- CSU patients had a higher baseline comorbidity burden but similar index admission mortality and complications.
- Higher 30-day readmission rates were noted for CSU patients.
- Outcomes during readmission did not differ significantly between CSU and non-CSU patients.
Background:
We characterized index admission outcomes and 30-day readmissions after cardiac surgery in patients with chronic steroid use (CSU) in a large national administrative database.
Methods:
Cardiac surgery patients (coronary artery bypass grafting, valve, aortic, and combinations) were identified in the 2016-2020 Nationwide Readmissions Database and stratified by CSU diagnosis. Mortality and complications during index admissions and 30-day readmissions were compared between patients with and without CSU after propensity score matching (PSM).
Results:
Overall, 1,332,806 cardiac surgery patients were identified; 12,082 (0.91%) with CSU and 1,320,724 (99%) without. Before PSM, more CSU patients were ≥ 75 years-old and female, and had anemia, chronic lung disease, renal failure, and prior stroke. Following PSM, no significant differences in characteristics remained between 12,082 patients with CSU and 47,180 without. Index admission mortality (3.2% vs. 3.6%; P = .09) and overall complications (45% vs. 44%; P = .24) were not significantly different. 30-day readmissions were higher among those with CSU (16% vs. 13%; P < .01). Among readmitted patients, mortality (4.9% vs. 3.7%; P = .17) and overall complications (53% vs. 51%; P = .29) were not significantly different.
Conclusions:
Patients with CSU had higher baseline comorbidity burden but did not have higher index admission mortality or complications. Patients with CSU were more often readmitted within 30 days of discharge, but their outcomes during readmissions were like those in patients without CSU.
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