Abstract 10471: Determining Mechanisms Underlying Rehospitalizations After Adult Cardiac Surgery
Introduction: Hospitals may face risk of financial penalties due to above target cardiac surgery rehospitalization rates. However, efforts to address rehospitalizations are hindered by an inadequate understanding of the primary drivers of these rehospitalizations.
Hypothesis: We hypothesized that a patient’s condition at discharge following cardiac surgery would inform our understanding of the need for subsequent rehospitalizations.
Methods: We identified 3,061 patients who underwent cardiac surgery from 1/2011 through 4/2012 at 13 adult cardiac surgery programs within a state quality collaborative. Centers followed patients up to 30 days beyond discharge. Abstractors collected additional information on patients who were rehospitalized, including status at discharge, follow-up plan, and subsequent care.
Results: Rehospitalizations occurred among 10.7% of patients (329/3061). Half (52.2%) of the rehospitalized patients presented within 7 days of discharge. Between the non-rehospitalized and rehospitalized patients, there were no significant differences in mean age (64.9 vs. 65.8 years, p=0.22) or gender (31.5% vs. 35.9% female, p=0.10), though rehospitalized patients had higher predicted risk of mortality, p<0.05. Only 31.9% of patients saw a healthcare provider prior to rehospitalization (57% in clinic, 20% in ER, 23% other). Fluid overload/shortness of breath (15.5%), infection (14.6%), arrhythmia (13.3%), pleural or pericardial effusion (12.0%), and recurrent chest pain (11.4%) were the leading 5 causes of rehospitalization. Subgroup analysis revealed more early (within 7 days) rehospitalizations for arrhythmia and vascular events and more late rehospitalizations for recurrent chest pain and infection (Figure).
Conclusions: Rehospitalizations are common and may be reduced through targeted early follow-up care to address medical conditions that may be appropriately addressed in an outpatient setting.
- © 2013 by American Heart Association, Inc.