Risk factors of readmission after coronary artery bypass graft surgery: A case-control study
Abstract
Background & Aim: Reducing readmissions is a major goal of health care systems. This study aimed to identify readmission risk factors following coronary artery bypass graft surgery.
Methods & Materials: This case-control study analyzed 540 patients who underwent coronary artery bypass graft surgery between January 2016 and December 2019 at Shahid Beheshti Hospital in Qom, Iran. The case group contained 270 patients who were readmitted to the hospital during the 30-day after discharge and the control group comprised 270 non-readmitted patients.
Results: Readmit patients suffered from higher rates of cardiac failure, myocardial infarction, hypertension, myocardial dysrhythmia, and using antiplatelet coagulant medication (P<0.05). Compared with non-readmitted patients, readmitted patients were more likely to have emergency surgery (OR 1.62; CI 1.11-2.38), cardiac arrest (OR 2.52; CI 2.39-2.85), and massive intraoperative hemorrhage during surgery (OR 2.36; CI 2.13-2.67). Postoperative disorders such as surgical site infection, pleural effusion, dysrhythmias, and myocardial infarction were independent risk factors for readmission (P<0.05).
Conclusion: Patients at risk for readmission should be closely monitored. Furthermore, careful decision-making about surgical criteria by a multidisciplinary team can help improve outcomes as well as reduce readmissions.
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19. Zywot A, Lau CSM, Glass N, Bonne S, Hwang F, Goodman K, et al. Preoperative Scale to Determine All-Cause Readmission After Coronary Artery Bypass Operations. The Annals of thoracic surgery. 2018;105(4):1086-93.
20. Benetis R, Sirvinskas E, Kumpaitiene B, Kinduris S. A case-control study of readmission to the intensive care unit after cardiac surgery. Medical science monitor : international medical journal of experimental and clinical research. 2013;19:148-52.
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22. Chu CL, Chiou HY, Chou WH, Chang PY, Huang YY, Yeh HM. Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data. BMC geriatrics. 2017;17(1):245.
23. Grocott MPW, Edwards M, Mythen MG, Aronson S. Peri-operative care pathways: re-engineering care to achieve the 'triple aim'. Anaesthesia. 2019;74 Suppl 1:90-9.
24. McNeely C, Kwedar K, Markwell S, Vassileva CM. Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the Medicare population. The Journal of Thoracic and Cardiovascular Surgery. 2017 Oct 1;154(4):1288-97.
25. Cheikh Hassan HI, Tang M, Djurdjev O, Langsford D, Sood MM, Levin A. Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality. Kidney international. 2016;90(4):897-904.
26. Friedman LS. Surgery in the patient with liver disease. Transactions of the American Clinical and Climatological Association. 2010;121:192-204; discussion 5.
27. Anis HK, Sodhi N, Coste M, Ehiorobo JO, Newman JM, Garbarino LJ, et al. A comparison of peri-operative outcomes between elective and non-elective total hip arthroplasties. Annals of translational medicine. 2019;7(4):78.
28. Amouzeshi A, Amouzeshi Z, Abbasi Teshnizi M, Moeinipour AA, Hosseinzadeh Maleki M. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery Outcomes During 6 Years: A Prospective Cohort Study. Acta medica Iranica. 2017;55(9):578-84.
29. Barili F, Rosato S, D'Errigo P, Parolari A, Fusco D, Perucci CA, et al. Impact of off-pump coronary artery bypass grafting on long-term percutaneous coronary interventions. The Journal of thoracic and cardiovascular surgery. 2015;150(4):902-9.e1-6.
30. Rodrigues AJ, Evora PR, Tubino PV. On-pump versus off-pump coronary artery bypass graft surgery: what do the evidence show? Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular. 2013;28(4):531-7.
2. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Annals of translational medicine. 2016;4(13):256.
3. Markle WH, Fisher MA, Smego RA. Understanding Global Health, 2E. McGraw Hill Professional; 2013 Oct 22.
4. Barstow C, McDivitt JD. Cardiovascular Disease Update: Care of Patients After Coronary Artery Bypass Graft. FP essentials. 2017;454:29-33.
5. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):e652-735.
6. Abbasi M, Mohammadi N, Nikbakht Nasrabadi A, Sadegi T. Experiences of living with coronary artery bypass graft: a qualitative study. Journal of hayat. 2014;19(4):38-47.
7. Herlitz J, Brandrup-Wognsen G, Evander MH, Caidahl K, Hartford M, Karlson BW, et al. Symptoms of chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(1):112-8.
8. Perrotti A, Ecarnot F, Monaco F, Dorigo E, Monteleone P, Besch G, et al. Quality of life 10 years after cardiac surgery in adults: a long-term follow-up study. Health and quality of life outcomes. 2019;17(1):88.
9. Nery RM, Martini MR, Vidor Cda R, Mahmud MI, Zanini M, Loureiro A, et al. Changes in functional capacity of patients two years after coronary artery bypass grafting surgery. Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular. 2010;25(2):224-8.
10. Abbasi M, Negarandeh R, Norouzadeh R, Mogadam ARS. The Challenges of living with an implantable cardioverter defibrillator: A Qualitative Study. Iranian Red Crescent Medical Journal. 2016;18(10) e25158.
11. Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. The American journal of emergency medicine. 2018;36(12):2289-97.
12. Feng TR, White RS, Gaber-Baylis LK, Turnbull ZA, Rong LQ. Coronary artery bypass graft readmission rates and risk factors - A retrospective cohort study. International journal of surgery (London, England). 2018;54(Pt A):7-17.
13. Fox JP, Suter LG, Wang K, Wang Y, Krumholz HM, Ross JS. Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. The Annals of thoracic surgery. 2013;96(1):96-104.
14. Hannan EL, Zhong Y, Lahey SJ, Culliford AT, Gold JP, Smith CR, et al. 30-day readmissions after coronary artery bypass graft surgery in New York State. JACC Cardiovascular interventions. 2011;4(5):569-76.
15. Rosenblum JM, Lovasik BP, Hunting JC, Binongo J, Halkos ME, Leshnower BG, et al. Predicted Risk of Mortality Score predicts 30-day readmission after coronary artery bypass grafting. General thoracic and cardiovascular surgery. 2019;67(8):661-8.
16. Bradley EH, Curry L, Horwitz LI, Sipsma H, Wang Y, Walsh MN, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation Cardiovascular quality and outcomes. 2013;6(4):444-50.
17. Gupta S, Zengul FD, Davlyatov GK, Weech-Maldonado R. Reduction in Hospitals' Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities. Inquiry : a journal of medical care organization, provision and financing. 2019;56:46958018817994.
18. Rennke S, Ranji SR. Transitional care strategies from hospital to home: a review for the neurohospitalist. The Neurohospitalist. 2015;5(1):35-42.
19. Zywot A, Lau CSM, Glass N, Bonne S, Hwang F, Goodman K, et al. Preoperative Scale to Determine All-Cause Readmission After Coronary Artery Bypass Operations. The Annals of thoracic surgery. 2018;105(4):1086-93.
20. Benetis R, Sirvinskas E, Kumpaitiene B, Kinduris S. A case-control study of readmission to the intensive care unit after cardiac surgery. Medical science monitor : international medical journal of experimental and clinical research. 2013;19:148-52.
21. Acton QA. Myocardial Ischemia: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyBrief: ScholarlyEditions; 2013.
22. Chu CL, Chiou HY, Chou WH, Chang PY, Huang YY, Yeh HM. Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data. BMC geriatrics. 2017;17(1):245.
23. Grocott MPW, Edwards M, Mythen MG, Aronson S. Peri-operative care pathways: re-engineering care to achieve the 'triple aim'. Anaesthesia. 2019;74 Suppl 1:90-9.
24. McNeely C, Kwedar K, Markwell S, Vassileva CM. Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the Medicare population. The Journal of Thoracic and Cardiovascular Surgery. 2017 Oct 1;154(4):1288-97.
25. Cheikh Hassan HI, Tang M, Djurdjev O, Langsford D, Sood MM, Levin A. Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality. Kidney international. 2016;90(4):897-904.
26. Friedman LS. Surgery in the patient with liver disease. Transactions of the American Clinical and Climatological Association. 2010;121:192-204; discussion 5.
27. Anis HK, Sodhi N, Coste M, Ehiorobo JO, Newman JM, Garbarino LJ, et al. A comparison of peri-operative outcomes between elective and non-elective total hip arthroplasties. Annals of translational medicine. 2019;7(4):78.
28. Amouzeshi A, Amouzeshi Z, Abbasi Teshnizi M, Moeinipour AA, Hosseinzadeh Maleki M. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery Outcomes During 6 Years: A Prospective Cohort Study. Acta medica Iranica. 2017;55(9):578-84.
29. Barili F, Rosato S, D'Errigo P, Parolari A, Fusco D, Perucci CA, et al. Impact of off-pump coronary artery bypass grafting on long-term percutaneous coronary interventions. The Journal of thoracic and cardiovascular surgery. 2015;150(4):902-9.e1-6.
30. Rodrigues AJ, Evora PR, Tubino PV. On-pump versus off-pump coronary artery bypass graft surgery: what do the evidence show? Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular. 2013;28(4):531-7.
| Files | ||
| Issue | Vol 7 No 4 (2020): Autumn | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v7i4.4039 | |
| Keywords | ||
| patient readmission; coronary artery bypass grafting; complications | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Alimadadi E, Abbasinia M, Mohammadbeigi A, Abbasi M. Risk factors of readmission after coronary artery bypass graft surgery: A case-control study. NPT. 2020;7(4):295-301.
