Prediction of readmissions after CABG using detailed follow-up data - The Israeli CABG Study (ISCAB)

OBJECTIVE. TO use detailed pre-discharge follow-up data to predict readmiss ions within 3 months after Coronary Artery Bypass Grafting (CABG). SETTINGS AND DESIGN. A Prospective nationwide study (ISCAB) of 4,835 patien ts undergoing isolated CABG in Israel in 1994. Survivors of the initial hos pitalization were candidates for the readmission study. METHODS. Patient information was prospectively collected from preoperative interviews and hospital follow-up. Readmissions' data were obtained from th e National Hospital Admission Registry. Logistic and multinomial models wer e constructed for total and cause-specific readmissions, respectively. RESULTS. Of CABG survivors, 1,094 (24.1%) were rehospitalized within 3 mont hs of the original surgery. Significant multivariate predictors of total re admissions included the following: preoperative co-morbidities; operative f actors; immediate post-operative complications and socio-demographic charac teristics as well as provider characteristics. However, the logistic model had low predictive power (c-statistic = 0.65). The heterogeneous reasons fo r readmissions were classified into specific serious cardiac diagnoses (19. 0%), other cardiac reasons (35.4%), specific infections at the site of the operation (10.2%), other infections (7.3%), and various other reasons (23.0 %). The multinomial model for cause-specific readmissions caused by either serious cardiac reasons or wound infection had a higher predictive value (c -statistics of 0.75, 0.72, respectively). CONCLUSIONS. Total readmissions after CABG in Israel were difficult to pred ict, even with an extensive pre-discharge follow-up data. We propose that r easons for readmission vary from true emergencies to nonspecific causes, wi th the latter related to a lack of support services in the community. We su ggest that cause-specific rehospitalizations could be a better outcome for evaluating quality of care.