Li Zhongmin, Armstrong Ehrin J, Parker Joseph P, Danielsen Beate, Romano Patrick S
University of California-Davis Medical Center, Sacramento, CA 95817, USA.
Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):729-37. doi: 10.1161/CIRCOUTCOMES.112.966945. Epub 2012 Sep 4.
Readmissions are common after coronary artery bypass grafting (CABG) surgery and account for a significant percentage of hospital healthcare costs. Readmission rates also vary widely between hospitals, but the reasons for this variation have not been studied previously.
We linked 2009 California CABG clinical registry data to hospital discharge data for 2009 and 2010 to identify 30-day readmissions for all patients undergoing isolated CABG surgery. Both standard and hierarchical logistic models were developed to predict readmission risk and explore sources of hospital readmission variation. Among 11 823 patients discharged alive after isolated CABG in 2009, 1565 (13.2%) patients were readmitted within 30 days of surgery. Heart failure and postoperative infections were the most frequent reasons for readmission (15.3% and 12.9%, respectively). Multiple patient risk factors, including age, sex, and lower zip code-level median household income, were significant predictors of readmission (all adjusted odds ratios >1.0; P<0.05). The readmission rates among the 119 hospitals performing CABG varied from 0% to 26.9%. Compared with hospitals in lower quartiles for readmission, hospitals in higher quartiles had a significantly higher readmission rates due to circulatory diseases, infections, complications for surgical and medical care and digestive diseases (all P<0.05). In a hierarchical model, including several hospital characteristics, hospital-level variables did not predict readmission risk (all P>0.05, with an intraclass correlation of 0.004 for hospitals).
California hospitals performing CABG surgery vary widely in 30-day readmission rates. Patient demographic and clinical risk factors, rather than measured hospital characteristics, accounted for most of the observed hospital-level variation in CABG readmissions.
冠状动脉旁路移植术（CABG）后再入院情况常见，占医院医疗费用的很大比例。各医院的再入院率差异也很大，但此前尚未对这种差异的原因进行研究。
我们将2009年加利福尼亚州CABG临床登记数据与2009年和2010年的医院出院数据相链接，以确定所有接受单纯CABG手术患者的30天再入院情况。开发了标准和分层逻辑模型来预测再入院风险并探讨医院再入院差异的来源。在2009年接受单纯CABG手术后存活出院的11823例患者中，1565例（13.2%）在术后30天内再次入院。心力衰竭和术后感染是再入院的最常见原因（分别为15.3%和12.9%）。包括年龄、性别和较低邮政编码区域家庭收入中位数在内的多个患者风险因素是再入院的显著预测因素（所有调整后的比值比>1.0；P<0.05）。进行CABG手术的119家医院的再入院率从0%到26.9%不等。与再入院率处于较低四分位数的医院相比，处于较高四分位数的医院因循环系统疾病、感染、手术和医疗护理并发症以及消化系统疾病导致的再入院率显著更高（所有P<0.05）。在一个包含多个医院特征的分层模型中，医院层面的变量并不能预测再入院风险（所有P>0.05，医院的组内相关系数为0.004）。
加利福尼亚州进行CABG手术的医院30天再入院率差异很大。患者的人口统计学和临床风险因素，而非所测量的医院特征，是观察到的CABG再入院医院层面差异的主要原因。
