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Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery.
Ann Thorac Surg. 2013 Jul; 96(1):96-104.AT

Abstract

BACKGROUND

There is growing interest in how frequently patients undergoing coronary artery bypass graft (CABG) surgery require hospital readmission within 30 days of discharge. Readmissions, however, may not capture all hospital-based, acute care needs after discharge. The purpose of this study is to describe the frequency of and diagnoses associated with emergency department (ED) visits and hospital readmissions within 30 days of discharge after CABG surgery and to compare outcomes across hospitals.

METHODS

Using the California State Inpatient and Emergency Department Databases, we identified all adults who underwent isolated CABG surgery between January 2005 and June 2009. We then calculated hospitals' 30-day, risk-standardized readmission and ED visit rates using hierarchic generalized linear models. The correlation between hospital readmission and ED visit rates was estimated, weighting for hospital volume.

RESULTS

We identified 63,911 adults who underwent isolated CABG surgery at 114 hospitals. Hospital 30-day, risk-standardized ED visit without readmission rates (median ED visit rate = 11.9%, 25th to 75th percentile, 10.5% to 13.7%) nearly equaled the hospital 30-day risk-standardized readmission rates (median readmission rate = 15.0%, 25th to 75th percentile, 13.5% to 16.5%). Both outcomes varied widely among hospitals. A composite of these outcomes, the median 30-day risk-standardized hospital-based, acute care rate was 23.9% (25th to 75th percentile, 22.2% to 25.5%). Postoperative infections, congestive heart failure, and chest discomfort were among the most common reasons for both readmissions and ED visits. Hospitals' 30-day risk-standardized ED visit and readmission rates were not significantly correlated (weighted correlation coefficient = -0.07, p = 0.44).

CONCLUSIONS

Patients discharged after CABG surgery frequently experienced ED visits and hospital readmissions within 30 days, often for similar diagnoses. Monitoring both hospital readmissions and ED visits after CABG surgery is important to our understanding of hospital-based, acute care needs after discharge.

Authors+Show Affiliations

Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton Ohio, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23702228

Citation

Fox, Justin P., et al. "Hospital-based, Acute Care Use Among Patients Within 30 Days of Discharge After Coronary Artery Bypass Surgery." The Annals of Thoracic Surgery, vol. 96, no. 1, 2013, pp. 96-104.
Fox JP, Suter LG, Wang K, et al. Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. Ann Thorac Surg. 2013;96(1):96-104.
Fox, J. P., Suter, L. G., Wang, K., Wang, Y., Krumholz, H. M., & Ross, J. S. (2013). Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. The Annals of Thoracic Surgery, 96(1), 96-104. https://doi.org/10.1016/j.athoracsur.2013.03.091
Fox JP, et al. Hospital-based, Acute Care Use Among Patients Within 30 Days of Discharge After Coronary Artery Bypass Surgery. Ann Thorac Surg. 2013;96(1):96-104. PubMed PMID: 23702228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. AU - Fox,Justin P, AU - Suter,Lisa G, AU - Wang,Karen, AU - Wang,Yongfei, AU - Krumholz,Harlan M, AU - Ross,Joseph S, Y1 - 2013/05/21/ PY - 2012/11/03/received PY - 2013/03/19/revised PY - 2013/03/22/accepted PY - 2013/5/25/entrez PY - 2013/5/25/pubmed PY - 2013/9/4/medline SP - 96 EP - 104 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 96 IS - 1 N2 - BACKGROUND: There is growing interest in how frequently patients undergoing coronary artery bypass graft (CABG) surgery require hospital readmission within 30 days of discharge. Readmissions, however, may not capture all hospital-based, acute care needs after discharge. The purpose of this study is to describe the frequency of and diagnoses associated with emergency department (ED) visits and hospital readmissions within 30 days of discharge after CABG surgery and to compare outcomes across hospitals. METHODS: Using the California State Inpatient and Emergency Department Databases, we identified all adults who underwent isolated CABG surgery between January 2005 and June 2009. We then calculated hospitals' 30-day, risk-standardized readmission and ED visit rates using hierarchic generalized linear models. The correlation between hospital readmission and ED visit rates was estimated, weighting for hospital volume. RESULTS: We identified 63,911 adults who underwent isolated CABG surgery at 114 hospitals. Hospital 30-day, risk-standardized ED visit without readmission rates (median ED visit rate = 11.9%, 25th to 75th percentile, 10.5% to 13.7%) nearly equaled the hospital 30-day risk-standardized readmission rates (median readmission rate = 15.0%, 25th to 75th percentile, 13.5% to 16.5%). Both outcomes varied widely among hospitals. A composite of these outcomes, the median 30-day risk-standardized hospital-based, acute care rate was 23.9% (25th to 75th percentile, 22.2% to 25.5%). Postoperative infections, congestive heart failure, and chest discomfort were among the most common reasons for both readmissions and ED visits. Hospitals' 30-day risk-standardized ED visit and readmission rates were not significantly correlated (weighted correlation coefficient = -0.07, p = 0.44). CONCLUSIONS: Patients discharged after CABG surgery frequently experienced ED visits and hospital readmissions within 30 days, often for similar diagnoses. Monitoring both hospital readmissions and ED visits after CABG surgery is important to our understanding of hospital-based, acute care needs after discharge. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/23702228/Hospital_based_acute_care_use_among_patients_within_30_days_of_discharge_after_coronary_artery_bypass_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(13)00738-8 DB - PRIME DP - Unbound Medicine ER -