Factors related to rehospitalization within thirty days of discharge after coronary artery bypass grafting.
BACKGROUND
Early rehospitalization after coronary artery bypass grafting (CABG) is an expensive and frequently adverse outcome. Rehospitalization rates after various surgical procedures have been used as an indicator of quality of care. Determining the extent to which rehospitalization rates reflect patient case mix and severity of illness rather than quality of care requires detailed information regarding the patients, the care they received, and the reasons for their rehospitalization.


METHODS
We conducted a nested case control study comparing 110 CABG patients who were rehospitalized within 30 days after discharge with 224 control patients. Control patients were randomly selected from patients undergoing CABG during the same time frame as the cases and were matched on age, gender, and priority of surgery. A detailed chart review provided information regarding treatment in the postsurgical period, in addition to the preoperative information collected on all CABG patients as part of an ongoing regional prospective study.


RESULTS
The overall rehospitalization rate was 13.8%. The most common reasons for rehospitalization included: wound infection (19%), atrial fibrillation (13%), pleural effusion (11%), and thromboembolic event (10%). Preoperative severity of illness and comorbidity accounted for 24% of the total variance. After adjustment for these factors, discharge hematocrit less than 30% (OR = 2.01, p = 0.018) and several discharge medications including: antiarrhythmics (OR = 3.26, p = 0.047), diuretics (OR = 2.18, p = 0.055), beta blockers (OR = 0.44, p = 0.036), and long length of stay (more than 7 days; OR = 2.09, p = 0.029) were the most important predictors of rehospitalization risk.


CONCLUSIONS
Although the reasons for rehospitalization after CABG are heterogeneous and related to patient severity of illness as well as comorbid status, several of the most common are potentially preventable and related to quality of care. Rehospitalization was not related to early discharge.
Beggs
V L
VL
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Birkemeyer
N J
NJ
Nugent
W C
WC
Dacey
L J
LJ
O'Connor
G T
GT
D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015999:Multivariate Analysis; D009513:New Hampshire; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D013997:Time Factors