Hannan Edward L, Racz Michael J, Walford Gary, Ryan Thomas J, Isom O Wayne, Bennett Edward, Jones Robert H
Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany 12144-3456, USA.
JAMA. 2003 Aug 13;290(6):773-80. doi: 10.1001/jama.290.6.773.
Risk factors for perioperative mortality after coronary artery bypass graft (CABG) surgery have been extensively studied. However, which factors are associated with early readmissions following CABG surgery are less clear.
To identify significant predictors of readmission within 30 days following CABG surgery.
DESIGN, SETTING, AND PATIENTS: Causes for readmission within 30 days were investigated for all patients discharged after CABG surgery in the state of New York from January 1, 1999, through December 31, 1999. A variety of patient demographics, preoperative risk factors, complications, operative and postoperative factors, and provider characteristics were considered as potential predictors of readmissions.
Hospital readmissions within 30 days of discharge following CABG surgery.
Of 16 325 total patients, 2111 (12.9%) were readmitted within 30 days for reasons related to CABG surgery. The most common causes of readmission were postsurgical infection (n = 598 [28%]) and heart failure (n = 331 [16%]). Eleven risk factors were found to be independently associated with higher readmission rates: older age, female sex, African American race, greater body surface area, previous myocardial infarction within 1 week, and 6 comorbidities. After controlling for these preoperative patient-level risk factors, 2 provider characteristics (annual surgeon CABG volume <100, hospital risk-adjusted mortality rate in the highest decile) and 2 postoperative factors (discharge to nursing home or rehabilitation/acute care facility, length of stay during index CABG admission of > or =5 days) were also related to higher readmission rates.
Readmission within 30 days following discharge is an important adverse outcome of CABG surgery. Continued attempts should be made to explore the potential of readmission as a supplement to mortality in assessing provider quality.
冠状动脉旁路移植术（CABG）后围手术期死亡率的危险因素已得到广泛研究。然而，哪些因素与CABG术后早期再入院相关尚不清楚。
确定CABG术后30天内再入院的显著预测因素。
设计、设置和患者：对1999年1月1日至1999年12月31日在纽约州接受CABG手术出院的所有患者进行了30天内再入院原因调查。各种患者人口统计学特征、术前危险因素、并发症、手术及术后因素以及医疗服务提供者特征均被视为再入院的潜在预测因素。
CABG手术后出院30天内的医院再入院情况。
在总共16325例患者中，2111例（12.9%）因与CABG手术相关的原因在30天内再次入院。再入院的最常见原因是术后感染（n = 598 [28%]）和心力衰竭（n = 331 [16%]）。发现11个危险因素与较高的再入院率独立相关：年龄较大、女性、非裔美国人种族、体表面积较大、1周内既往心肌梗死以及6种合并症。在控制了这些术前患者层面的危险因素后，2个医疗服务提供者特征（每年外科医生CABG手术量<100、医院风险调整死亡率处于最高十分位数）和2个术后因素（出院至养老院或康复/急性护理机构、首次CABG入院期间住院时间≥5天）也与较高的再入院率相关。
出院后30天内再入院是CABG手术的一个重要不良结局。应继续努力探索将再入院作为评估医疗服务提供者质量时死亡率补充指标的潜力。
