Weill Cornell Medicine-New York Presbyterian Hospital, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY, 10065, USA.
Weill Cornell Medicine, Center for Perioperative Outcomes, 428 East 72nd St., Suite 800A, New York, NY, 10021, USA.
Int J Surg. 2018 Jun;54(Pt A):7-17. doi: 10.1016/j.ijsu.2018.04.022. Epub 2018 Apr 17.
Hospital readmissions contribute substantially to the overall healthcare cost. Coronary artery bypass graft (CABG) is of particular interest due to its relatively high short-term readmission rates and mean hospital charges.
A retrospective review was performed on 2007-2011 data from California, Florida, and New York from the State Inpatient Databases, Healthcare Cost and Utilization Project. All patients ≥18 years of age who underwent isolated CABG and met inclusion/exclusion criteria were included. Insurance status was categorized by Medicaid, Medicare, Private Insurance, Uninsured, and Other. Primary outcomes were unadjusted rates and adjusted odds of readmission at 30- and 90-days. Secondary outcomes included diagnosis at readmission.
A total of 177,229 were included in the analyses after assessing for exclusion criteria. Overall 30-day readmission rate was 16.1%; rates were highest within Medicare (18.4%) and Medicaid (20.2%) groups and lowest in the private insurance group (11.7%; p < 0.0001). Similarly, 90-day rates were highest in Medicare (27.3%) and Medicaid (29.8%) groups and lowest in the private insurance group (17.6%), with an overall 90-day rate of 24.0% (p < 0.0001). The most common 30-day readmission diagnoses were atrial fibrillation (26.7%), pleural effusion (22.5%), and wound infection (17.7%). Medicare patients had the highest proportion of readmissions with atrial fibrillation (31.7%) and pleural effusions (23.3%), while Medicaid patients had the highest proportion of readmissions with wound infections (21.8%). Similar results were found at 90 days. Risk factors for readmission included non-private insurance, age, female sex, non-white race, low median household income, non-routine discharge, length of stay, and certain comorbidities and complications.
CABG readmission rates remain high and are associated with insurance status and racial and socioeconomic markers. Further investigation is necessary to better delineate the underlying factors that relate racial and socioeconomic disparities to CABG readmissions. Understanding these factors will be key to improving healthcare outcomes and expenditure.
医院再入院对整体医疗保健成本有重大影响。由于其相对较高的短期再入院率和平均住院费用，冠状动脉旁路移植术（CABG）尤其受到关注。
对加利福尼亚州、佛罗里达州和纽约州 2007-2011 年的州住院患者数据库和医疗保健成本与利用项目进行回顾性分析。纳入年龄≥18 岁，行单纯 CABG 且符合纳入/排除标准的患者。保险状况分为医疗补助、医疗保险、私人保险、无保险和其他。主要结局为 30 天和 90 天未调整的再入院率和调整后的再入院率。次要结局包括再入院时的诊断。
在评估排除标准后，共有 177229 例患者纳入分析。总体 30 天再入院率为 16.1%；医疗保险（18.4%）和医疗补助（20.2%）组的再入院率最高，私人保险组（11.7%）最低（p<0.0001）。同样，医疗保险（27.3%）和医疗补助（29.8%）组的 90 天再入院率最高，私人保险组（17.6%）最低，总体 90 天再入院率为 24.0%（p<0.0001）。最常见的 30 天再入院诊断为心房颤动（26.7%）、胸腔积液（22.5%）和伤口感染（17.7%）。医疗保险患者心房颤动（31.7%）和胸腔积液（23.3%）的再入院比例最高，而医疗补助患者伤口感染（21.8%）的再入院比例最高。90 天也有类似结果。再入院的风险因素包括非私人保险、年龄、女性、非白种人、中低收入家庭、非常规出院、住院时间以及某些合并症和并发症。
CABG 的再入院率仍然很高，与保险状况以及种族和社会经济指标有关。需要进一步研究以更好地阐明与 CABG 再入院相关的种族和社会经济差异的潜在因素。了解这些因素将是改善医疗保健结果和支出的关键。
