Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, Los Angeles, California.
Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, Los Angeles, California; University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Ann Thorac Surg. 2020 Sep;110(3):849-855. doi: 10.1016/j.athoracsur.2019.11.058. Epub 2020 Jan 22.
Reducing inpatient readmissions is a national priority for improving healthcare quality and decreasing costs. Previous studies have shown that readmissions after surgical aortic valve replacement are frequent and contribute to increased healthcare costs, yet no studies have analyzed risk factors for readmission.
The Nationwide Readmissions Database was used to identify adult patients undergoing surgical aortic valve replacement from 2010 to 2015. Incidence, patient characteristics, causes, resource utilization, and predictors of 30-day readmission were determined. International Classification of Diseases codes were used to capture surgical aortic valve replacement.
Among 136,051 patients, 18,631 (13.7%) were readmitted within 30 days of discharge. Readmitted patients were more commonly women (47.4% vs 41.6%; P < .001) and were older (70.4 years of age vs 68.3 years of age; P < .001), with higher Elixhauser comorbidity index (5.4 vs 4.8; P < .001), rates of postoperative complications (44.0% vs 37.3%; P < .001), and greater length of stay (10.9 days vs 8.5 days; P < .001). The mean cost of 1 readmission episode was $13,426. On multivariable analysis, significant predictors of readmission were female sex, age greater than 75 years, atrial fibrillation, chronic kidney and liver disease, and lower surgical aortic valve replacement hospital volume. A total of 49.1% of readmissions were related to cardiac causes, with heart failure (13.2%) and arrhythmia (12.5%) being the most common.
Using a national inpatient database, we found readmission after surgical aortic valve replacement to be common and resource-intensive. Enhanced management of comorbidities and targeted postdischarge interventions for patients at high risk of readmission may help decrease healthcare utilization.
降低住院患者再入院率是提高医疗质量和降低成本的国家重点。先前的研究表明，主动脉瓣置换术后再入院率较高，增加了医疗成本，但尚无研究分析再入院的危险因素。
使用全国再入院数据库确定了 2010 年至 2015 年期间接受主动脉瓣置换手术的成年患者。确定了 30 天再入院的发生率、患者特征、原因、资源利用和预测因素。使用国际疾病分类代码捕捉主动脉瓣置换手术。
在 136051 例患者中，有 18631 例（13.7%）在出院后 30 天内再次入院。再入院患者中女性患者更为常见（47.4%比 41.6%；P<.001），年龄更大（70.4 岁比 68.3 岁；P<.001），Elixhauser 合并症指数更高（5.4 比 4.8；P<.001），术后并发症发生率更高（44.0%比 37.3%；P<.001），住院时间更长（10.9 天比 8.5 天；P<.001）。单次再入院的平均费用为 13426 美元。多变量分析表明，再入院的显著预测因素为女性、年龄大于 75 岁、心房颤动、慢性肾病和肝病，以及较低的主动脉瓣置换手术医院容量。49.1%的再入院与心脏原因有关，心力衰竭（13.2%）和心律失常（12.5%）是最常见的原因。
使用全国住院患者数据库，我们发现主动脉瓣置换术后再入院很常见，且资源消耗量大。增强对合并症的管理和对高再入院风险患者的针对性出院后干预措施可能有助于降低医疗保健利用率。
