title: Prospective evaluation of patients readmitted after cardiac surgery: analysis of outcomes and identification of risk factors.
abstract: OBJECTIVE
  Reducing hospital readmissions after adult cardiac surgery is necessary as part of the solution to achieving improved efficiency in health care. Patients who had undergone cardiac surgery were studied to develop strategies that may diminish the need for hospital readmission.
  
  
  METHODS
  Over a 25-month period, 2096 patients underwent cardiac surgical procedures; 102 of these patients required readmission within 30 days of discharge. Time-matched patients (n = 249), not readmitted, served as a control group. Patient demographics and perioperative variables were analyzed by univariate analyses. Logistic regression analysis identified independent risk factors for readmission.
  
  
  RESULTS
  The most common diagnoses given for readmission were congestive heart failure (26 of 102, 25%), infection (23 of 102, 23%), and arrhythmias (15 of 102, 15%). The comorbidities more prevalent among readmitted patients were diminished ejection fraction (44% ± 17% vs 56% ± 13%; P < .0001), chronic obstructive pulmonary disease (23 of 102, 23% vs 23 of 249, 9%; P = .0008) and chronic renal insufficiency (26 of 102, 26% vs 24 of 249, 10%; P = .0001). Multivariate logistic regression identified chronic obstructive pulmonary disease (odds ratio [OR], 2.0; P = .05), diminished ejection fraction (OR, 0.8; P < .0001), a lower education level (OR, 0.5; P = .0001), and a prolonged length of stay (OR, 1.6; P = .009) as predictive of readmission. Failure to see a physician early in the postoperative period was associated with a 6-fold increase in the risk of readmission (P < .0001).
  
  
  CONCLUSIONS
  Patients readmitted after cardiac surgery have specific comorbidities and are of lower socioeconomic status. They are admitted most commonly for exacerbation of congestive heart failure or infectious reasons. This study suggests that seeing a physician early after discharge may have an impact on reducing readmissions after cardiac surgery.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: faxmaniarh@wudosis.wustl.edu.
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bell
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Marsala
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lawton
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome