title: Causes of readmission after operation for congenital heart disease.
abstract: BACKGROUND
  Readmission after operations for congenital heart conditions has significant implications for patient care. Readmission rates vary between 8.7% and 15%. The aim of this study was to determine the incidence, causes, and risk factors associated with readmission.
  
  
  METHODS
  811 consecutive patients undergoing operations for congenital heart conditions were analyzed. Readmission was defined as admission to any hospital within 30 days of discharge for any cause. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate comparisons were made between the nonreadmission and readmission groups, and multivariate logistic regression analysis was made to determine independent risk factors for readmission.
  
  
  RESULTS
  There were a total of 92 readmissions in 79 patients (9.7%). The reasons included cardiac (36, 39%), pulmonary (20, 22%), gastrointestinal (13, 14%), infectious (20, 22%), and other adverse events (2, 2%). Patients with either single-ventricle palliation or nasogastric feeding accounted for 40 (50%) readmissions. On univariate analysis, there were significant differences between readmitted and nonreadmitted patients in relation to patient age, chromosomal abnormality, mortality risk score, duration of mechanical ventilation, postoperative length of stay, single-ventricle physiology, and nasogastric feeding at discharge (p < 0.05). On multivariate analysis, significant risk factors for readmission were single-ventricle physiology (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.28 to 4.47; p=0.005), preoperative arrhythmia (OR 2.59; 95% CI 1.02 to 6.59; p=0.04), longer postoperative length of stay (OR 2.2; 95% CI 1.22 to 3.99; p=0.008), and nasogastric tube feeding at discharge (OR 2.2; 95% CI 1.15 to 4.19; p=0.01).
  
  
  CONCLUSIONS
  The incidence of readmission after operations for congenital cardiac conditions remains high. Efforts focusing on patients with single-ventricle palliation and those with preoperative arrhythmia, prolonged postoperative length of stay and nasogastric tube feeding at discharge may be particularly beneficial.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon. Electronic address: saharan@ohsu.edu.
authors.forename: Sunil
authors.initials: S
authors.lastname: Saharan
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Legg
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Laurie B
authors.initials: LB
authors.lastname: Armsby
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: M Mujeeb
authors.initials: MM
authors.lastname: Zubair
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
mesh_terms: D006348:Cardiac Surgical Procedures; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D016017:Odds Ratio; D009922:Oregon / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors