Frequency and Risk Factors of Unplanned 30-Day Readmission After Open Heart Surgeries: A Retrospective Study in a Tertiary Care Center
DOI:
https://doi.org/10.1532/hsf.4875Keywords:
risk factors, readmission, Open heart surgeries, CABG, Valve, Frequency, UnplannedAbstract
Background: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned readmission rate, determinants, and most common events within 30 days post-cardiac surgery. Recommendations to prevent or minimize these complications are included.
Methods: Setting and design – a retrospective record review was conducted among all adult patients, who underwent open heart surgery between 2010 and 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia.
Using Google Forms, we manually collected data from hospital records. Statistical analysis used: binomial logistic regression model (using the backward stepwise method). Regression outcomes were expressed as odds ratios (ORs) and 95% CIs. A P-value of < 0.05 indicated statistical significance.
Results: Among 400 patients who underwent cardiac surgery, 343 patients were included in the study, including 53 unplanned readmissions, which was a rate of 16.3% (95% CI, 12.8 to 20.6%). The most frequently reported reasons for readmission were sternal wound infections (7.3%), pleural effusion (2.0%), and heart failure (1.7%). Female gender, high postoperative LDH and urea were the most important risk factors.
Conclusion: Discharge planning, patient education, and cardiac surgery nurse home visit constitute the most important factors to minimize 30 days of unplanned readmission.
References
Abdallah F. 2012. Neuropshychiatric complications after cardiac surgery. Facaulty Med Alexandria Univ. 18–20.
Abdelnabey S, Elfeky H, Mohamed WY, Badr SA. 2014. Readmission after Open Heart Surgery: Study of Predictors and Frequency. Badr J Biol Agric Healthc. 4:7.
Al-Ebrahim KE. 2022. Conventional coronary bypass remains the gold standard reference technique. Journal of Cardiac Surgery. Feb 13.
Al-Ebrahim KE, Al-Ebrahim E. 2020. Prevention, Classification and Management Review of Deep Sternal Wound Infection. Heart Surg Forum. Sep 14;23(5):E652-E657.
Al-Ebrahim KE, Elassal AA, Eldib OS, Abdalla AHA, Allam ARA, Al-Ebrahim EK, Abdelmohsen GA, Dohain AM, Al-Radi OO. 2019. Diaphragmatic palsy after cardiac surgery in adult and pediatric patients. Asian Cardiovasc Thorac Ann. Jul;27(6):481-485.
Beggs VL, Birkemeyer NJ, Nugent WC, Dacey LJ, O’Connor GT. 1996. Factors related to rehospitalization within thirty days of discharge after coronary artery bypass grafting. Best Pract benchmarking Healthc a Pract J Clin Manag Appl. 1(4):180–6.
Benuzillo J, Caine W, Evans RS, Roberts C, Lappe D, Doty J. 2018. Predicting readmission risk shortly after admission for CABG surgery. J Card Surg. 33(4):163–70.
Bharadwaj P, Luthra M. 2008. Coronary artery revascularisation: Past, present and future. Med J Armed Forces India. 64(2):154–7.
Boeken A. 2011. ICU-readmission after cardiac surgery: predictors and consequences.
Case R, George J, Li Q, Arnaoutakis GJ, Keeley EC. 2020. Unplanned 30-day readmission after coronary artery bypass in patients with acute myocardial infarction. Cardiovasc Revascularization Med. 21(4):518–21.
Chan J, Rosenfeldt F, Chaudhuri K, Marasco S. 2012. Cardiac surgery in patients with a history of malignancy: increased complication rate but similar mortality. Hear Lung Circ. 21(5):255–9.
Hannan EL, Zhong Y, Lahey SJ, Culliford AT, Gold JP, Smith CR, et al. 2011. 30-day readmissions after coronary artery bypass graft surgery in New York State. JACC Cardiovasc Interv. 4(5):569–76.
Hirji SA, Percy ED, Zogg CK, Vaduganathan M, Kiehm S, Pelletier M, et al. 2020. Thirty-day nonindex readmissions and clinical outcomes after cardiac surgery. Ann Thorac Surg. 110(2):484–91.
Iribarne A, Chang H, Alexander JH, Gillinov AM, Moquete E, Puskas JD, et al. 2014. Readmissions after cardiac surgery: experience of the NIH/CIHR Cardiothoracic Surgical Trials Network. Ann Thorac Surg. 98(4):1274.
Keenan PS, Normand S-LT, Lin Z, Drye EE, Bhat KR, Ross JS, et al. 2008. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 1(1):29–37.
Landrum L, Weinrich S. 2006. Readmission data for outcomes measurement: identifying and strengthening the empirical base. Qual Manag Healthc. 15(2):83–95.
Li Z, Amstrong EJ, Parker JP, Danielsen B, Romano PS. 2012. Hospital variation in readmission after coronary artery bypass surgery in California. Circ Cardiovasc Qual Outcomes. 5(5):729–37.
Mendis S, Puska P, Norrving B editors, Organization WH. 2011. Global atlas on cardiovascular disease prevention and control. World Health Organization.
Redžek A, Mironicki M, Gvozdenović A, Petrović M, Čemerlić-Ađić N, Ilić A, et al. 2015. Predictors for hospital readmission after cardiac surgery. J Card Surg Incl Mech Biol Support Hear Lungs. 30(1):1–6.
Sabourin CB, Funk M. 1999. Readmission of patients after coronary artery bypass graft surgery. Hear lung. 28(4):243–50.
Saquib N, Zaghloul MS, Mazrou A, Saquib J. 2017. Cardiovascular disease research in Saudi Arabia: a bibliometric analysis. Scientometrics. 112(1):111–40.
Shah RM, Zhang Q, Chatterjee S, Cheema F, Loor G, Lemaire SA, et al. 2019. Incidence, cost, and risk factors for readmission after coronary artery bypass grafting. Ann Thorac Surg. 107(6):1782–9.
Stanton BA, Jenkins CD, Goldstein RL, Vander Salm TJ, Klein MD, Aucoin RA. 1985. Hospital readmissions among survivors six months after myocardial revascularization. JAMA. 253(24):3568–73.
Trooboff SW, Magnus PC, Ross CS, Chaisson K, Kramer RS, Helm RE, et al. 2019. A multi-center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group. J Card Surg Incl Mech Biol Support Hear Lungs. 34(8):655–62.
Weiss MG, Møller JE, Dahl JS, Riber L, Sibilitz KL, Lykking EK, et al. 2020. Causes and characteristics associated with early and late readmission after open-heart valve surgery. J Card Surg. 35(4):747–54.
Zitser-Gurevich Y, Simchen E, Galai N, Braun D. 1999. Prediction of readmissions after CABG using detailed follow-up data: the Israeli CABG Study (ISCAB). Med Care. 625–36.
