Vassileva Christina M, Ghazanfari Naseem, Spertus John, McNeely Christian, Markwell Stephen, Hazelrigg Stephen
Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
Ann Thorac Surg. 2014 Nov;98(5):1544-50. doi: 10.1016/j.athoracsur.2014.07.040. Epub 2014 Sep 22.
Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates after mitral valve repair (MVP) and replacement (MVR).
We included 21,138 Medicare beneficiaries with primary isolated MVP (n=6,896) or MVR (n=14,242) from 2000 through 2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF.
Preoperative HF was present in 61.0% of the patients. All-cause readmission rates were 24.9% at 30 days and 78.0% at 5 years. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared with those without for MVP (2.1% vs 5.9% in 30 days and 10.3% vs 26.3% in 5 years) and 2 times higher for MVR (3.6% vs 7.4% in 30 days and 15.8% vs 30.4% in 5 years). Regardless of procedure type, patients without preoperative HF had significantly lower HF readmission rates (3.0% vs 7.0% in the first 30 days and 13.6% vs 29.2% after 5 years) (p=0.0001).
Hospital readmission after mitral surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Because admission for heart failure accounts for a significant proportion of these readmissions, close follow-up of patients with known mitral valve disease and referral to surgery prior to development of heart failure may decrease postoperative readmission rates.
再入院率已被公认为心力衰竭（HF）的一项质量指标。我们分析了二尖瓣修复术（MVP）和置换术（MVR）后的心力衰竭再入院率。
我们纳入了2000年至2004年期间21138名患有原发性孤立性二尖瓣狭窄（n = 6896）或二尖瓣置换术（n = 14242）的医疗保险受益人。在为期5年的随访期间，使用索引程序后的MedPar记录确定再入院率。将死亡视为竞争风险，分析累积再入院发生率，并根据术前是否存在心力衰竭进行分层。
61.0%的患者术前存在心力衰竭。全因再入院率在30天时为24.9%，5年时为78.0%。与无术前心力衰竭的患者相比，有术前心力衰竭的患者因心力衰竭再入院的累积发生率在MVP患者中几乎高出3倍（30天时为2.1%对5.9%，5年时为10.3%对26.3%），在MVR患者中高出2倍（30天时为3.6%对7.4%，5年时为15.8%对30.4%）。无论手术类型如何，无术前心力衰竭的患者心力衰竭再入院率显著较低（前30天为3.0%对7.0%，5年后为13.6%对29.2%）（p = 0.0001）。
二尖瓣手术后的医院再入院率很高。术前心力衰竭与术后再入院率较高相关。由于因心力衰竭入院占这些再入院的很大比例，对已知二尖瓣疾病患者进行密切随访并在心力衰竭发生前转诊至手术可能会降低术后再入院率。
