title: National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999-2010.
abstract: BACKGROUND
  Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals.
  
  
  METHODS
  We included 100% of Medicare Fee-for-Service patients ≥65 years of age who underwent MVS between 1999-2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race).
  
  
  RESULTS
  The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999-2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65-74: 47.4% to 44.4%; 75-84: 51.4% to 49.2%, ≥85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18).
  
  
  CONCLUSIONS
  Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.
authors.affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America.
authors.forename: Karthik
authors.initials: K
authors.lastname: Murugiah
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Zack
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Sabet
authors.initials: S
authors.lastname: Hashim
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America.
authors.forename: Sudhakar V
authors.initials: SV
authors.lastname: Nuti
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Erica
authors.initials: E
authors.lastname: Spatz
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Nihar
authors.initials: N
authors.lastname: Desai
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America; RWJ Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D006278:Medicare; D008943:Mitral Valve / Q000601:surgery*; D010359:Patient Readmission; D014481:United States / Q000453:epidemiology