Rosenblum Joshua M, Lovasik Brendan P, Hunting John C, Binongo Jose, Halkos Michael E, Leshnower Bradley G, Miller Jeffrey S, Lattouf Omar M, Guyton Robert A, Keeling William B
Division of Cardiac Surgery, Department of Surgery, The Emory Clinic, Emory University School of Medicine, 1365 Clifton Rd, Suite A2202, Atlanta, GA, 30322, USA.
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Gen Thorac Cardiovasc Surg. 2019 Aug;67(8):661-668. doi: 10.1007/s11748-019-01079-6. Epub 2019 Feb 8.
Quality metrics and reimbursement models focus on 30-day readmission rates after coronary artery bypass grafting (CABG). Certain preoperative variables are associated with higher rates of readmission. The purpose of this study was to determine whether STS Predicted Risk of Mortality (PROM) scores predict 30-day readmission following CABG.
A retrospective review of all patients undergoing isolated CABG between 2002 and 2017 at a US academic institution was performed. Logistic regression analysis was used to determine the association between PROM and 30-day readmission, and the area under the receiver-operator curve (ROC) was calculated to estimate predictive accuracy.
During the study period, 21,719 patients underwent CABG and 2,023 (9.2%) were readmitted within 30 days. Readmitted patients were sicker with higher rates of comorbid conditions and higher STS PROM scores (1.03% vs 1.42%, GMR 1.33, CI 1.27-1.38, p < 0.0001). Median time to readmission was 8 days (IQR 4-15) with length of stay 5 days (4-6). By PROM quintile, higher PROM scores were associated with increased odds of readmission. PROM-adjusted 30-day mortality was higher in the readmitted group (1.04% vs 0.21%, OR 4.53, CI 2.67-7.69, p < 0.001), and mid-term survival was worse as well. PROM alone was a modest predictor of readmission (area under ROC 0.59, CI 0.57-0.60) compared to insurance status (0.55, 0.53-0.56), ejection fraction (0.52, 0.50-0.54), and history of heart failure (0.51, 0.50-0.52).
STS PROM scores are associated with increased risk of readmission following CABG.
质量指标和报销模式聚焦于冠状动脉旁路移植术（CABG）后的30天再入院率。某些术前变量与较高的再入院率相关。本研究的目的是确定胸外科医师协会（STS）预测死亡率（PROM）评分是否能预测CABG后的30天再入院情况。
对2002年至2017年间在美国一家学术机构接受单纯CABG的所有患者进行回顾性研究。采用逻辑回归分析确定PROM与30天再入院之间的关联，并计算受试者工作特征曲线（ROC）下面积以估计预测准确性。
在研究期间，21719例患者接受了CABG，其中2023例（9.2%）在30天内再次入院。再入院患者病情更重，合并症发生率更高，STS PROM评分也更高（1.03%对1.42%，广义危险比1.33，可信区间1.27 - 1.38，p＜0.0001）。再入院的中位时间为8天（四分位间距4 - 15天），住院时间为5天（4 - 6天）。按PROM五分位数划分，较高的PROM评分与再入院几率增加相关。再入院组经PROM调整的30天死亡率更高（1.04%对0.21%，比值比4.53，可信区间2.67 - 7.69，p＜0.001），中期生存率也更差。与保险状态（0.55，0.53 - 0.56）、射血分数（0.52，0.50 - 0.54）和心力衰竭病史（0.51，0.50 - 0.52）相比，单独的PROM是再入院的一个中等预测指标（ROC下面积0.59，可信区间0.57 - 0.60）。
STS PROM评分与CABG后再入院风险增加相关。
