Readmission after Open Heart Surgery: Study of Predictors and Frequency

Abstract

Background: Hospital readmissions after cardiac procedures are believed to be associated with higher in-hospital mortality and may predict poor outcomes. In addition high rate of readmission following discharge is associated with increased cost of care. Therefore, awareness of factors that predict increased risk for hospital readmission after cardiac surgery may improve the ability to reduce early readmission rates among this category of patients. Aim of the study; to assess predictors for hospital readmission after cardiac surgery. Design: A descriptive exploratory design was utilized in the current study. Subjects: A sample of Convenience including 115 adult male & female patients who were admitted to the cardiothoracic surgery departments at Kasr Al-Aini Hospital, Cairo University over a period of six months were recruited. Tools of data collection: Four tools were utilized to collect data pertinent to the current study: Socio-demographic/medical data sheet; Perioperative open heart surgery assessment Sheet; Hospital readmission assessment sheet; and the LACE index Scale (Lengths of hospital stay in days; Acuity of illness at the time of admission; Carlson co-morbidity score; and Emergency department visits numbers during previous six months. Results: the current study revealed that the majority of the studied sample were males, married, having an elective admission with percentages of (67.8%), (86.1%) & (87%) respectively, and nearly half of them were between 40–59 years & came from rural area in percentages of (50%) & (52.2%) respectively. Out of the 115 patients who discharged from the hospital 18 % required a second hospital and ICU readmission. Main reasons for readmissions were wound problems (42.9%), congestive heart failure (14.3%), atrial fibrillation (9.5%), pleural effusion (9.5%), renal failure (9.5%) and respiratory failure (4.8%). Binary logistic regression analysis revealed that preoperative renal failure, delayed extubation (mechanical ventilation > 8 h), re-exploration for bleeding, perioperative use of intraaortic ballon pump (IABP), postoperative dysrhythmias, postoperative heart failure and postsurgical (ICU) length of stay (> 3 day) were independent predictors for readmission. Conclusion & Recommendations: Based on findings of the current study, it can be concluded that readmission following discharge is an important adverse outcome of cardiac surgery that needs continued attempts to explore and manage the risk factors of readmission. So the study recommends identification & close monitoring of those at risk for readmission; Establishment of hot line services for providing proper consultation after hospital discharge, especially for emergent cases; and provision of surveillance units for detection of high risk patients.

Keywords: Open Heart Surgery- Hospital Readmission-Predictors- Frequency.