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Predicting 30-day readmission after congenital heart surgery across the lifespan

Published online by Cambridge University Press:  05 August 2020

Ian Everitt Open the ORCID record for Ian Everitt [Opens in a new window] ,
Trenton Hoffman ,
Cheryl Raskind-Hood ,
Fred H. Rodriguez ,
Carol Hogue  and
Wendy M. Book
Ian Everitt*
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA
Trenton Hoffman
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Cheryl Raskind-Hood
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Fred H. Rodriguez
Affiliation:
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Sibley Heart Center Cardiology, Atlanta, GA, USA
Carol Hogue
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Wendy M. Book
Affiliation:
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
*
Author for correspondence: Ian K. Everitt MD MPH, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA30322, USA. Tel: +312-926-2000. E-mail: ian.everitt@northwestern.edu
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Abstract

Introduction:

Hospital readmission is an important driver of costs among patients with CHD. We assessed predictors of 30-day rehospitalisation following cardiac surgery in CHD patients across the lifespan.

Methods:

This was a retrospective analysis of 981 patients with CHD who had cardiac surgery between January 2011 and December 2012. A multivariate logistic regression model was used to identify demographic, clinical, and surgical predictors of 30-day readmission. Receiver operating curves derived from multivariate logistic modelling were utilised to discriminate between patients who were readmitted and not-readmitted at 30 days. Model goodness of fit was assessed using the Hosmer–Lemeshow test statistic.

Results:

Readmission in the 30 days following congenital heart surgery is common (14.0%). Among 981 patients risk factors associated with increased odds of 30-day readmission after congenital heart surgery through multivariate analysis included a history of previous cardiac surgery (p < 0.001), longer post-operative length of stay (p < 0.001), as well as nutritional (p < 0.001), haematologic (p < 0.02), and endocrine (p = 0.04) co-morbidities. Patients who underwent septal defect repair had reduced odds of readmission (p < 0.001), as did children (p = 0.04) and adult (p = 0.005) patients relative to neonates.

Conclusion:

Risk factors for readmission include a history of cardiac surgery, longer length of stay, and co-morbid conditions. This information may serve to guide efforts to prevent readmission and inform resource allocation in the transition of care to the outpatient setting. This study also demonstrated the feasibility of linking a national subspecialty registry to a clinical and administrative data repository to follow longitudinal outcomes of interest.

Keywords

CHDcongenital heart surgeryreadmission
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 9 , September 2020 , pp. 1297 - 1304
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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