Early readmission for congestive heart failure predicts late mortality after cardiac surgery.
OBJECTIVE
Early readmission in patients hospitalized for medical congestive heart failure is common, expensive, and associated with a worse late survival. Our objective was to compare late survival in patients' readmission for congestive heart failure with readmission for other causes in patients undergoing cardiac surgery.


METHODS
Of 3654 consecutive patients undergoing cardiac surgery at a single institution between April 2004 and June 2010, 3492 (96%) were discharged from the hospital before 30 days and analyzed. Survival curves by readmission reason were compared using the log-rank test. Multivariable analyses adjusted for patient demographics, known preoperative cardiac risk factors, and surgical characteristics.


RESULTS
The readmission rate at 30 days was 13% (465/3492): 23% for arrhythmias/heart block, 12% for congestive heart failure, 40% for surgery related causes, 14% for infection, and 11% for noncardiac causes. Independent risk factors for readmission include age, gender, congestive heart failure, and cardiopulmonary bypass time. Eight percent (268/3492) of discharged patients died within the 6-year study: 14% in the readmission group versus 7% in the nonreadmission group (P < .01). Patients who had been readmitted for congestive heart failure had worse late survivals compared with all patients who had been readmitted for causes related to their surgery.


CONCLUSIONS
Readmission within 30 days after cardiac surgery for congestive heart failure predicts late mortality. Targeted postoperative management may be warranted in patients with surgical congestive heart failure.
Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA. ricklee@nmh.org
Richard
R
Lee
Natalie
N
Homer
Adin-Cristian
AC
Andrei
Edwin C
EC
McGee
S Chris
SC
Malaisrie
Preeti
P
Kansal
Patrick M
PM
McCarthy
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D002641:Chicago; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors