Hospital readmissions in children with congenital heart disease: a population-based study.

BACKGROUND

Little is known about the factors that predispose children with congenital heart disease (CHD) to readmission soon after hospital discharge. We sought to determine rates and risk factors for hospital readmission within 1 month among children with CHD.

METHODS

Data were obtained from administrative databases that record all hospitalizations within the province of Quebec. We included children 0 to 17 years with CHD who were hospitalized with a cardiac diagnosis (an "index hospitalization") between 1990 and 2005. Cox proportional hazards analysis was used to identify predictors of readmission.

RESULTS

Among 3675 hospitalizations, there were 518 readmissions (15%) within 31 days. Median time to readmission was 12 days (interquartile range 5-19 days). Readmissions occurred in the same hospital as the index hospitalization 86% of the time. The most common diagnoses at readmission were cardiac (59%) and respiratory illnesses (12%). Independent predictors of readmission were severe CHD lesion, younger age, Friday or Saturday discharge, having an emergency department visit within the preceding 6 months, length of index hospitalization > 14 days, and multiple (> or = 4) diagnoses (either cardiac diagnoses or comorbid conditions). Having an invasive procedure during the index hospitalization reduced the likelihood of readmission.

CONCLUSIONS

Readmission occurred after 1 in 7 hospitalizations. Infants and patients with severe CHD lesions were among those more likely to be readmitted. The risk of readmission may be reduced by avoiding hospital discharge at the beginning of a weekend. Further studies are needed to determine if targeted interventions will reduce readmission rates in high-risk patients.