A Risk Prediction Model of Readmission for Chinese Patients after Coronary Artery Bypass Grafting
Keywords:coronary artery bypass grafting, readmission, risk prediction model
Background: Predictive models can be used to assess the risk of readmission for patients after coronary artery bypass grafting (CABG). However, the majority of the existing prediction models have been developed based on data of western population. Our objective was to develop and validate a risk prediction model for Chinese patients after CABG.
Methods: This study was conducted among 1983 patients who underwent CABG in Wuhan Asian Heart Hospital from January 2017 to October 2019. Pearson's chi-squared and multivariate logistic regression were performed to investigate the risk factors of readmission after CABG. The area under the ROC curve and Hosmer-Lemeshow test were used to validate the discrimination and calibration of the model, respectively.
Results: Six risk factors were predictive of readmission: age≥65 years (odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.11-4.34; P = 0.024), female (OR = 2.46; 95%CI: 1.26-4.80; P = 0.008), private insurance (OR = 4.23; 95%CI: 1.11-16.11; P = 0.034), diabetes (OR = 2.351; 95%CI: 1.20-4.59; P = 0.012), hypertension (OR = 2.33; 95%CI: 1.16-4.66; P = 0.017), and congenital heart disease (OR = 6.93;95%CI: 2.04-23.52; P = 0.002). The area under the curve c-statistic was 0.876 in the derivation sample and 0.865 in the validation sample. Hosmer-Lemeshow test: P=0.561.
Conclusion: The risk prediction model in our study can be used to predict the risk of readmission in Chinese patients after CABG.
Alejandra J, Ultraviolet P, Fischer MO, ET AL. 2019. Conspiratorial and cooperative atrial fibrillation occurrence in cardiac surgery patients: Rationale and design of the ALDOCURE trial. Am Heart J. 214:88-96.
Amanda-Michel E, Bianca V, Sultan I, Gleason TG, Avid F, Kilim A. 2019. Predictors of increased costs following index adult cardiac operations: Insights from a statewide publicly reported registry. J Card Burg. 34(8):708-713.
Amati H, Finnan A, Hake F, ET AL. 2015. Assessment of the Euro Score risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients. Indian J Brit Care Med. 19(10):576-579.
Austin PC, Lee DS, Diagnostics RB, Fine JP. 2016. Developing points-based risk-scoring systems in the presence of competing risks [published correction appears in Stat Med. 2018 Apr 15;37(8):1405]. Stat Med. 35(22):4056-4072.
Bates OL, O'Connor N, Dunn D, Hansen SM. 2014. Applying STAAR interventions in incremental bundles: improving post-CAB surgical patient care. Worldviews Avid Based Burs. 11(2):89-97.
Bertillon J, Cain W, Evans RS, Roberts C, Apple D, Dory J. 2018. Predicting readmission risk shortly after admission for CABG surgery. J Card Burg. 33(4):163-170.
Centers for Medicare and Medicaid Servicewoman Department of Health & Human. 2016. Admissions Reduction Program (HRRP). Available at: HTTP://WWW.cms.gov/medicare/medicare-fee-for-service payment/outpatients/admissions-reduction-program.HTML.
Deng TR, White RS, Berg-Basilisk LK, Turn bull ZA, Bong LQ. 2018. Coronary artery bypass graft readmission rates and risk factors - A retrospective cohort study. Int J Burg. 54(Pt A):7-17.
Han EL, Thong Y, Haley SJ, ET AL. 2011. 30-day Admissions after coronary artery bypass graft surgery in New York State. JACC Cardiologist Inter. 4(5):569-576.
Hour H, Ghanaian Y, Tulsidas SE, Burdock AL, Hares S, Haberdasher P. 2019. Admissions Following Isolated Coronary Artery Bypass Graft Surgery in the United States (from the Nationwide Admissions Database 2010 to 2014). Am J Cardiology. 124(2):205-210.
Jia Y, Zhou Y, Chen Y, Shen Y. 2019. Study on comprehensive evaluation system of clinical prediction model (in Chinese). Chinese J Health Stat. 36(5):728-734.
Kong G, Bu DL, Body R, Yang B, Backwardness K, Barley S. 2012. A belief rule-based decision support system for clinical risk assessment of cardiac chest pain [J]. European Journal of Operational Research. 219(3).
Lin CY, Asperity M, Pompadour AH, ET AL. 2017. Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Centiliter, Randomized Controlled Trial with 18-Month Follow-Up. Drugs Aging. 34(2):143-156.
Patchouli M, Satanical F, Sheridan M, Cook CC. 2019. Incidence, Predictors, and Outcomes of Early Acute Cardinal Infarction Following Coronary Artery Bypass Grafting. Am J Cardiology. 124(7):1027-1030.
Price JD, Dreiser JL, Wagoner JM, Shyer AL, Rosenberg TK. 2013. Risk analysis for readmission after coronary artery bypass surgery: developing a strategy to reduce Admissions. J Am Coll Burg. 216(3):412-419.
Saunders R, Candlewick J. 2019. The Cost Effectiveness of Single-Patient-Use Electrocardiograph Cable and Lead Systems in Monitoring for Coronary Artery Bypass Graft Surgery. Front Cardiologist Med. 6:61. Published May 10.
Shah RM, Bhang Q, Chattel S, ET AL. 2019. Incidence, Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting. Ann Thor ac Burg. 107(6):1782-1789.
Tagger DP. 2018. How I deploy arterial grafts. Ann Cardiograph Burg. 7(5):690-697.
Tam DY, Fang J, Tran A, ET AL. 2018. A Clinical Risk Scoring Tool to Predict Readmission After Cardiac Surgery: An Ontario Administrative and Clinical Population Database Study. Can J Cardiology. 34(12):1655-1664.
Woodward M, Pre-install H, Peters SA. 2017. Graphics and statistics for cardiology: clinical prediction rules. Heart. 103(7):538-545.
Woozy A, La CSM, Glass N, ET AL. 2018. Preoperative Scale to Determine All-Cause Readmission After Coronary Artery Bypass Operations. Ann Thor ac Burg. 105(4):1086-1093.
Yuan X, Zheng Z, Hu S. 2012. Application value of EuroSCORE in predicting readmission after coronary artery bypass graft (in Chinese). Journal of Shandong University (Health Sciences). 50(8):77-80.
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