Hospitals readmit 1 in 5 patients after cardiac operations

Almost one in five patients who undergo cardiac surgery get readmitted, with the vast majority rehospitalized within 30 days. The findings, published in the October issue of the Annals of Thoracic Surgery, have implications for future quality measures.

The Centers for Medicare & Medicaid Services withholds reimbursement to hospitals for readmissions for heart failure, MI and pneumonia if they exceed expected rates. “Although readmission penalties currently do not apply to cardiac surgical procedures, many policy experts anticipate that penalties will be expanded in the near future,” wrote Alexander Iribarne, MD, MS, of the cardiovascular and thoracic surgery department at Duke University Medical Center in Durham, N.C., and colleagues.

Using the prospective observational study, Management Practices and the Risk of Infections Following Cardiac Surgery, they analyzed data from 5,059 patients who underwent cardiac operations in 2010. Their goal was to assess the rates and frequency of readmissions and identify risk factors.

The overall readmission rate totaled 18.7 percent. CABG, the most common procedure, had a rate of 14.9 percent. Less frequent but more complicated procedures had higher rates.

Most readmissions occurred within 30 days of discharge, with 80.6 percent of patients readmitted in that window. The median time for a first readmission was 22 days.

“Although the 30-day time point for examining readmissions has often been criticized as clinically arbitrary, our analysis demonstrates that the 30-day period captures most of the readmissions,” Iribarne observed.   

Female gender, treatment for diabetes mellitus or chronic obstructive pulmonary disease and longer operations were predictors of readmission. Infections, arrhythmias, volume overload and pleural effusions led the list for the most common causes of 30-day readmissions, at 17.1 percent, 17.1 percent, 13.5 percent and 10.1 percent, respectively.

Some readmissions may be preventable, which is at the crux of the readmission penalty initiative. The penalties are meant to prod hospitals into reducing their rates of costly readmissions and improving quality of patient care. Iribarne et al targeted infections and pleural effusions as two opportunities for adopting evidence-based strategies that improve outcomes.

“Given that median time from the operation to the first readmission in our study was 22 days, one simple solution might be for patients to return to the hospital earlier for their first scheduled postoperative visit,” they suggested.

For more on readmissions in cardiac surgery, please read “CABG Readmissions: Not Your Garden Variety Measure.”