Abstract 16959: Predicting Cardiovascular Intensive Care Unit Readmission After Cardiac Surgery: Derivation of a Clinical Prediction Model From 10,055Surgical Cases
Background: Cardiovascular intensive care unit readmissions (CVICU) after cardiac surgery are associated with longer CVICU lengths of stay (LOS) and a higher risk of mortality. Studies reporting risk for CVICU readmission have been methodologically limited by small numbers of outcomes, unreported measures of calibration or discrimination, or a lack of information spanning the entire peri-operative period.
Methods: A total of 10,055 patients ≥18 years in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease APPROACH) registry who underwent cardiac surgery (coronary artery bypass or valvular surgery) between 2004 and 2012 and were discharged alive from the first CVICU admission were included. A clinical prediction model using 21 pre/ peri-operative and 19 post-operative variables was derived using logistic regression. Model discrimination and calibration were assessed using area under the receiver operative curve (AUC) and the Hosmer-Lemeshow test, respectively.
Results: A total of 489 (4.9%) patients required CVICU readmission. The mean CVICU LOS for the first CVICU admission (7.4 Standard Deviation [SD] 11.8 vs 2.7 SD 5.2 days, p<0.001) and in-hospital mortality (13.8 % vs 1.8%, p<0.001) were higher among patients readmitted to the CVICU. A total of 40 variables were included in the final model and 14 covariates were positively associated (p<0.05) with CVICU readmission (Table). The clinical prediction model has good discrimination (AUC c= 0.82) and calibration (Hosmer-Lemeshow χ2=7.99, p=0.434).
Conclusion: In a large population based dataset incorporating a comprehensive set of peri-operative variables, we have derived a clinical prediction model with excellent discrimination and calibration. This model identifies opportunities for targeted therapeutic interventions aimed at reducing CVICU readmissions in high risk patients.
- © 2013 by American Heart Association, Inc.