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Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

ABSTRACT: Objectives:Coronary artery bypass grafting (CABG) is among the most frequently performed cardiac surgical procedures. However, it is associated with high readmission rates for a plethora of causes, which can substantially increase healthcare costs. This study aimed to assess the rates and associated risk factors of 30-day readmissions for CABG patients. Methods:We conducted this retrospective cohort study at King Abdulaziz Medical City. The study targeted adult patients who underwent CABG between January 1, 2016, and January 31, 2019. Data were extracted from the BEST Care system. Frequencies and percentages were generated for categorical variables. Mean and standard deviation were calculated for quantitative variables. Bivariable and multivariable logistic regressions were used to detect readmission risk factors. Results:Among 534 adult patients, the overall 30-day readmission rate was 16.1% (n = 86). The multivariable logistic regression analysis showed that diabetes mellitus (P = .002), amiodarone use (P = .04), statin use (P = .04), amlodipine use (P = .006), asthma (P < .001), and hyperlipidemia (P = .04) were significantly correlated with 30-day readmission. Conclusions:Our study showed an estimated 16.1% 30-day readmission rate after CABG. Diabetes mellitus, asthma, hyperlipidemia, and use of medications such as amiodarone, statins, and amlodipine were associated with readmission. Further studies are needed to develop tailored and practical strategies to reduce CABG readmissions and mitigate patient and health care facility burdens.

SUBMITTER: Alghafees MA

PROVIDER: S-EPMC7479155 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

Alghafees Mohammad A MA Alsubaie Noura A NA Alsadoon Linah K LK Aljafari Salman A SA Alshehri Eyad A EA Suliman Ihab F IF

Journal of Taibah University Medical Sciences 20200626 4

<h4>Objectives</h4>Coronary artery bypass grafting (CABG) is among the most frequently performed cardiac surgical procedures. However, it is associated with high readmission rates for a plethora of causes, which can substantially increase healthcare costs. This study aimed to assess the rates and associated risk factors of 30-day readmissions for CABG patients.<h4>Methods</h4>We conducted this retrospective cohort study at King Abdulaziz Medical City. The study targeted adult patients who underw ...[more]

PMID: 32982632

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Project description:BACKGROUND:Restrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG). METHODS:We retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: "high" (above) and "low" (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (<8 g/dL) discharge Hb levels on 30-day readmission rates by dividing the patients into 4 anemia cohorts based on discharge Hb levels: "no anemia" (>12 g/dL), "mild anemia" (10-11.9 g/dL), "moderate anemia" (8-9.9 g/dL), and "severe anemia" (<8 g/dL). Risk adjustment accounted for age, sex, Charlson comorbidity index, preoperative comorbidities, revision sternotomy, and patient blood management program implementation. RESULTS:The "high" and "low" groups had similar patient characteristics except for Hb levels (mean discharge Hb was 10.4 ± 0.9 vs 8.5 ± 0.6 g/dL, respectively). Notably, no evidence for a difference in 30-day readmission rates was noted between the "high" (76/746; 10.2%) and "low" (97/806; 12.0%) (P = .25) Hb cohorts. The 4 anemia cohorts had differences in age, revision sternotomy incidence, Hb levels, certain patient comorbidities, and time to readmission. On multivariable analysis, the risk-adjusted odds of readmission in the "low" Hb cohort (odds ratio, 1.16; 95% confidence interval, 0.84-1.61; P = .36) was not significant compared to the "high" Hb cohort. Compared to patients with discharge Hb ?8 g/dL, patients with Hb <8 g/dL had a higher incidence of readmission (22/129; 17.1% vs 151/1423; 10.6%; P = .036). On multivariable analysis, Hb <8 g/dL on discharge was predictive of readmission (odds ratio, 1.77; 95% confidence interval, 1.05-2.88; P = .03). The most common reason for readmission was volume overload, followed by infection and arrhythmias. CONCLUSIONS:A discharge Hb level below the institution mean for CABG patients does not provide evidence for an association with an increased 30-day readmission rate. In the small number of patients discharged with Hb <8 g/dL, there is a suggestion of increased risk for readmission and larger more controlled studies are needed to verify or refute this finding.

Project description:BackgroundPostoperative delirium (POD) is a common complication of major surgery and is associated with fortified morbidity, mortality, and long-term cognitive dysfunction. This study sought to evaluate the incidence and risk factors of delirium in elderly (aged ≥65 years) patients who underwent coronary artery bypass grafting (CABG).MethodsWe performed a retrospective cohort analysis. The clinical data of 1,426 elderly patients who underwent CABG at our hospital from October 2018 to October 2020 were collected and analyzed. Delirium was defined as any positive Confusion Assessment Method for Intensive Care Unit examination following surgery during the intensive care unit (ICU) stay. Risk factors for POD were authenticated via univariate and multivariate logistic regression analyses. The intraoperative and postoperative factors were evaluated using a propensity score-matched regression analysis based on preoperative factors.ResultsA total of 39.3% (560 of 1,426) of elderly patients who underwent CABG were diagnosed with delirium. Based on the multivariate analysis, age [odds ratio (OR) 1.013], long-term alcohol consumption (OR 2.026), diabetes (OR 1.51), stroke (OR 1.41), and extracardiac arteriopathy (OR 1.61) were found to be independent predictors of post-cardiac surgery delirium. Conversely, high-density lipoprotein cholesterol levels (HDL-C) ≥1.0 mmol/L (OR 0.71) was found to be a protective factor. Among the intraoperative and postoperative factors evaluated, only a prolonged ICU stay (≥48 h; OR 1.62) was identified as a risk factor for developing delirium in the propensity-score matched analysis, after adjusting for potential confounding variables and selection bias. In contrast to the earlier analysis, the multivariate logistic regression further revealed that peri-procedural myocardial infarction and postoperative arterial oxygen partial pressures were not significantly associated with POD.ConclusionsThe incidence of POD in elderly patients undergoing CABG was high. Factors such as older age, long-term alcohol consumption, diabetes, stroke, and extracardiac arteriopathy were independent risk factors for POD in these patients. In relation to the intraoperative and postoperative factors, after adjusting for preoperative confounding factors, only a prolonged ICU stay was identified as a risk factor for POD. Additionally, high levels of HDL-C may be beneficial in reducing the incidence of delirium.

Project description:ImportanceCoronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care.ObjectiveTo examine CABG payment variation and its drivers.Design, setting, and participantsThis retrospective cohort study used Medicare and private payer claims to identify patients who underwent nonemergent CABG surgery from January 1, 2012, through October 31, 2015. Ninety-day price-standardized, risk-adjusted, total episode payments were calculated for each patient, and hospitals were divided into quartiles based on the mean total episode payments of their patients. Payments were then subdivided into 4 components (index hospitalization, professional, postacute care, and readmission payments) and compared across hospital quartiles. Seventy-six hospitals in Michigan representing a diverse set of geographies and practice environments were included.Main outcomes and measuresNinety-day CABG episode payments.ResultsA total of 5910 patients undergoing nonemergent CABG surgery were identified at 33 of the 76 hospitals; of these, 4344 (73.5%) were men and mean (SD) age was 68.0 (9.3) years. At the patient level, risk-adjusted, 90-day total episode payments for CABG varied from $11 723 to $356 850. At the hospital level, the highest payment quartile of hospitals had a mean total episode payment of $54 399 compared with $45 487 for the lowest payment quartile (16.4% difference, P < .001). The highest payment quartile hospitals compared with the lowest payment quartile hospitals had 14.6% higher index hospitalization payments ($34 992 vs $30 531, P < .001), 33.9% higher professional payments ($8060 vs $6021, P < .001), 29.6% higher postacute care payments ($7663 vs $5912, P < .001), and 35.1% higher readmission payments ($3576 vs $2646, P = .06). The drivers of this variation are diagnosis related group distribution, increased inpatient evaluation and management services, higher utilization of inpatient rehabilitation, and patients with multiple readmissions.Conclusions and relevanceWide variation exists in 90-day CABG episode payments for Medicare and private payer patients in Michigan. Hospitals and clinicians entering bundled payment programs for CABG should work to understand local sources of variation, with a focus on patients with multiple readmissions, inpatient evaluation and management services, and postdischarge outpatient rehabilitation care.

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Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

Publications

Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

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