Risk factors for early hospital readmission after cardiac operations

Objective: Early hospital readmissions after cardiac procedures are both co stly and harmful to patients. We investigated the factors that predispose t o readmission to develop strategies to minimize this problem. Methods: As part of a prospective data collection, patients having cardiac procedures at our institution are routinely tracked for 30 days after their discharge from the hospital. We reviewed 2650 patients in our cardiac data base who underwent operations over the past 5 years. We used univariate and multivariate statistical techniques to identify risks for readmission. Results: Of 2574 discharged patients, 252 (9.8%) required readmission. The most common causes of readmission are cardiac (42%). pulmonary ( 19%), gast rointestinal (10%), extremity complications (6.7%, deep vein thrombophlebit is. peripheral arterial vascular disease, and saphenous vein harvest site p roblems), sternal wound problems (7.5%), and metabolic problems (4%). Of mo re than 70 variables studied, only 6 are significant multivariate predictor s of readmission: female sex (P =.002); diabetes (P =.001); chronic lung pr oblems (P =.011); increased distance between home and hospital (P >.001); p reoperative atrial fibrillation (P =.002): and preoperative chronic renal i nsufficiency (P =.002). Type of operation, redo procedures, and other intra operative and postoperative variables are not important multivariate predic tors of readmission. Prolonged hospital length of stay for the initial proc edure did not cause more frequent readmission. The costs of initial hospita lization (operating room costs combined with postoperative in-hospital cost s) were not significantly increased in those patients who required readmiss ion. Conclusions: The high-risk patient for readmission is a woman with diabetes , chronic lung disease, renal insufficiency, and preoperative atrial fibril lation who lives at a distance from the hospital. Readmission does not depe nd on periprocedural variables (eg, cardiopulmonary bypass time) or on post operative complications. High procedural costs from the initial hospitaliza tion do not predispose to readmission. These results suggest interventions that may reduce readmission.