Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2019 Dec;108(6):1729-1737. doi: 10.1016/j.athoracsur.2019.07.033. Epub 2019 Aug 31.
Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the risk factors and costs associated with readmissions after mitral valve (MV) surgery in a large, nationally representative cohort.
Adult patients undergoing MV repair or replacement were queried from the National Readmissions Database from 2010 to 2014. Data were collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure, and patient-level risk factors as determined by multivariable logistic regression.
Among 76,342 patients undergoing MV surgery, the rate of 30-day readmission was 17.0%. Those undergoing replacement procedures had significantly higher readmission rates (20.7% vs 13.1%; P < .001) compared with repair. Significant independent predictors of readmission after both MV repair and replacement included length of stay ≥8 days, chronic lung disease, chronic renal disease, and low hospital procedural volume for MV surgery. Readmissions to nonindex hospitals accounted for 26.6% of all readmissions. The most common indications for readmission were heart failure (21.4%), arrhythmia (17.0%) and respiratory diagnoses (15.0%), and infections (10.2%). The mean cost per readmission was $15,397, and among readmitted patients, the cost of readmission accounted for 17.8% of the total cost of the episode of care.
Nearly 1 in 5 patients undergoing MV surgery are readmitted within 30 days. Treatment at a low-volume center was strongly associated with readmission, and much of the readmission burden falls on nonindex hospitals. Further characterization of readmissions may improve the quality of care associated with MV surgery.
手术后再入院是医疗质量日益受到关注的指标。我们试图在一个大型的全国代表性队列中，估计二尖瓣（MV）手术后再入院的相关风险因素和成本。
从 2010 年至 2014 年，从全国再入院数据库中查询了接受 MV 修复或置换的成年患者的数据。收集了 30 天内再入院的发生率和再入院的指征，以及通过多变量逻辑回归确定的医院、手术和患者水平的风险因素。
在 76342 例行 MV 手术的患者中，30 天再入院率为 17.0%。与修复相比，接受置换手术的患者再入院率显著更高（20.7%比 13.1%；P<0.001）。MV 修复和置换术后再入院的独立显著预测因素包括住院时间≥8 天、慢性肺部疾病、慢性肾脏疾病和 MV 手术医院程序量低。非索引医院的再入院占所有再入院的 26.6%。再入院的主要原因是心力衰竭（21.4%）、心律失常（17.0%）和呼吸系统疾病（15.0%）以及感染（10.2%）。每次再入院的平均费用为 15397 美元，在再入院患者中，再入院的费用占该次住院总费用的 17.8%。
近 1/5 的接受 MV 手术的患者在 30 天内再入院。在低容量中心的治疗与再入院密切相关，并且大部分再入院负担落在非索引医院。进一步描述再入院情况可能会提高 MV 手术相关的医疗质量。
