Abstract 11661: Readmissions Following Congenital Heart Surgery in Infants and Children
Introduction: Thirty-day readmission among infants and children after congenital heart surgery (CHS) has been under studied despite the complexity and vulnerability of these patients.
Hypothesis: Readmissions after pediatric CHS are common. There exist risk factors for unplanned readmission.
Methods: We obtained State Inpatient Databases for Washington, New York, Florida, and California 2009-2011 and selected admissions < 19 years with ICD-9 CM codes indicating CHS. We defined readmission as non-elective hospitalization for a given patient < 31 days of discharge from the index CHS admission. We examined patient demographic and clinical variables and defined complications using the Society of Thoracic Surgeons Congenital Heart complication short list. Case mix was adjusted by using Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) categories. We defined High Resource Use (HRU) admissions as those > 90th percentile for total hospital charges. Multivariate analyses using generalized estimating equations estimated to adjusted odds for readmission.
Results: Among 8,585 index admissions we identified 967 readmissions (11.3%). Median length of stay for readmissions was 5 days, median total charge of $31,973 and mortality rate 1.8%. Among readmissions 16 (1.6%) were for another CHS of which 44% were HRU, complication rate 88% and mortality 6.25%. Common indications for readmission were Pulmonary (pleural effusion, respiratory distress, pneumonia/bronchiolitis), Cardiac (heart failure, pericardial effusion), Infectious (fever, UTI), and GI (dehydration, feeding difficulty, GERD). On multivariable analysis age 1 month - 1 year (adjusted odds ratio [AOR] 1.3 p=0.01); Hispanic AOR 1.2 p=0.03; government-insurance AOR 1.3 p=0.01; RACHS-1 3 complexity AOR 2.4 p<0.001; RACHS-1 4+ complexity 2.0 p=0.001; HRU AOR 1.4 p=0.02; complications AOR 1.1 p=0.04; and emergent index admission AOR 2.0 p<0.001 were risk factors for readmission.
Conclusions: Over 11% of pediatric CHS admissions result in unplanned readmission. CHS during readmission had higher resource use, complications and death rates. Hispanic race, government insurance, HRU, higher case complexity, complications and emergent index admission are risk factors for readmission.
Author Disclosures: O. Benavidez: None. W. He: None.
- © 2015 by American Heart Association, Inc.