Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Semin Thorac Cardiovasc Surg. 2021 Winter;33(4):1027-1034. doi: 10.1053/j.semtcvs.2020.12.015. Epub 2021 Feb 16.
The aim of the current study was to assess the impact of hospital readmissions within 30-days of discharge, on long-term postoperative outcomes. All patients who underwent cardiac surgery from 2011 - 2018 were included. Patients who had transcatheter procedures, VAD, and transplant were excluded. Inverse probability of treatment weighting (IPTW) propensity scoring was used for population risk adjustment. Multivariable analysis was performed to identify association with long-term mortality and readmission. The total risk adjusted (propensity scoring with IPTW) patient population consisted of 14,538 patients divided into those who were not readmitted in 30-days (nonreadmitted) (n = 12,627) and patients who were readmitted within 30-days (30-day readmitted) (n = 1911). Following IPTW, all baseline characteristics and postoperative complications were equivalent between cohorts (SMD <0.10). Patients who required intraoperative [OR 1.178 (1.05, 1.32); P = 0.006] and postoperative [1.32 (1.18, 1.48); P < 0.001] blood transfusions were at greater risk for 30-day readmission. Median follow-up period was 4.19 years (2.45 - 6.10). The 30-day readmission cohort had a significantly higher mortality risk during early (6 months) follow-up [HR 2.49 (2.01-3.10); P < 0.001] and late (60 months) follow-up [HR 1.30 (1.16-1.47); P < 0.001]. After risk adjustment, the 30-day readmission cohort was significantly associated with increased mortality over the study follow-up period [HR 1.62 (1.48, 1.78); P < 0.001]. 30-day readmissions were an independent predictor of subsequent long-term hospital readmission [HR 1.61 (1.50, 1.73); P < 0.001]. Patients who require 30-day readmissions following cardiac surgery are at increased risk of long-term mortality and repeat readmissions. Early postoperative hospital readmission may be a marker for worse long-term outcomes in cardiac surgery.
本研究旨在评估出院后 30 天内的再入院对长期术后结局的影响。所有接受心脏手术的患者均纳入研究。排除接受经导管治疗、心室辅助装置和移植的患者。采用逆概率治疗加权（Inverse probability of treatment weighting，IPTW）倾向评分进行人群风险调整。采用多变量分析确定与长期死亡率和再入院的相关性。总风险调整（使用 IPTW 进行倾向评分）患者人群包括 14538 例患者，分为 30 天内未再入院（未再入院）（n=12627）和 30 天内再入院（30 天再入院）（n=1911）患者。经过 IPTW，两组间所有基线特征和术后并发症均相当（SMD<0.10）。术中（比值比 1.178[1.05，1.32]；P=0.006）和术后（1.32[1.18，1.48]；P<0.001）需要输血的患者再入院风险更高。中位随访时间为 4.19 年（2.45-6.10）。30 天再入院组在早期（6 个月）随访时的死亡率风险显著升高[风险比 2.49[2.01-3.10]；P<0.001]和晚期（60 个月）随访[风险比 1.30[1.16-1.47]；P<0.001]。经过风险调整后，30 天再入院组在整个研究随访期间与死亡率升高显著相关[风险比 1.62[1.48，1.78]；P<0.001]。30 天再入院是随后长期住院再入院的独立预测因素[风险比 1.61[1.50，1.73]；P<0.001]。心脏手术后 30 天内再入院的患者发生长期死亡和再次再入院的风险增加。术后早期住院再入院可能是心脏手术后长期结局较差的标志物。
