Sun Xiumei, Zhang Li, Lowery Robert, Petro Kathleen R, Hill Peter C, Haile Elizabeth, Garcia Jorge M, Bafi Ammar S, Boyce Steven W, Corso Paul J
Department of Cardiac Surgery, Washington Hospital Center, Washington, DC, USA.
Heart Surg Forum. 2008 Dec;11(6):E327-32. doi: 10.1532/HSF98.20071192.
Early readmission after coronary artery bypass grafting (CABG) is an expensive adverse outcome. Although the perioperative experience of high-risk CABG patients has been studied extensively, little attention has been paid to low-risk CABG patients. The primary goal of this study was to identify the preoperative characteristics and to define risk predictors of readmission and preventive factors for readmission in low-risk isolated-CABG patients.
We identified 2157 patients who underwent CABG between January 2000 and December 2005 at Washington Hospital Center, Washington, DC, and defined as low risk patients who had a Parsonnet bedside risk score lower than the 25th percentile. Patients who were rehospitalized within 30 days after surgery were compared with those who were not rehospitalized during this period.
The overall readmission rate for this study cohort was 6.3%. Compared with non-readmitted patients, early-readmitted patients were more likely to have diabetes mellitus (27.94% versus 20.88%, P = .05) and less likely to have hypertension (42.65% versus 51.36%, P = .05). Blood product transfusion (P < .01), postoperative length of intensive care unit stay (P = .01), and length of hospital stay (P = .05) were all significantly increased in the readmitted patients. The use of beta-blockers (P = .03) and angiotensin-converting enzyme inhibitors (P = .04) was significantly lower at discharge in this group of patients; however, multivariate regression analysis demonstrated diabetes (odds ratio, 1.59; 95% confidence interval, 1.08-2.42) to be the only independent predictor of early readmission.
For low-risk CABG patients, diabetes mellitus is the risk predictor of early readmission. Early discharge was not associated with early readmission.
冠状动脉旁路移植术（CABG）后早期再入院是一种代价高昂的不良结局。尽管对高危CABG患者的围手术期情况已进行了广泛研究，但对低危CABG患者关注甚少。本研究的主要目的是确定低危单纯CABG患者的术前特征，明确再入院的风险预测因素及再入院的预防因素。
我们确定了2000年1月至2005年12月在华盛顿特区华盛顿医院中心接受CABG的2157例患者，并将Parsonnet床边风险评分低于第25百分位数的患者定义为低危患者。将术后30天内再次住院的患者与在此期间未再次住院的患者进行比较。
本研究队列的总体再入院率为6.3%。与未再次入院的患者相比，早期再次入院的患者更易患糖尿病（27.94%对20.88%，P = 0.05），患高血压的可能性较小（42.65%对51.36%，P = 0.05）。再次入院患者的血液制品输注量（P < 0.01）、术后重症监护病房住院时间（P = 0.01）和住院时间（P = 0.05）均显著增加。该组患者出院时β受体阻滞剂（P = 0.03）和血管紧张素转换酶抑制剂（P = 0.04）的使用显著减少；然而，多因素回归分析表明糖尿病（比值比，1.59；95%置信区间，1.08 - 2.42）是早期再入院的唯一独立预测因素。
对于低危CABG患者，糖尿病是早期再入院的风险预测因素。早期出院与早期再入院无关。
