title: Readmissions after adult congenital heart surgery: Frequency and risk factors.
abstract: OBJECTIVE
  Despite their clinical importance, 30-day readmission after adult congenital heart surgery has been understudied. They sought to determine the frequency of unplanned readmissions after adult congenital heart surgery and to identify any potential associated risk factors.
  
  
  METHODS
  Retrospective cohort study using State Inpatient Databases for Washington, New York, Florida, and California from 2009 to 2011.
  
  
  METHODS
  Federal and nonfederal acute care hospitals.
  
  
  METHODS
  Admissions of patients age 18-49 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating adult congenital heart surgery.
  
  
  METHODS
  Readmission was defined as any nonelective hospitalization for a given patient ≤30 days of discharge from the index congenital heart surgery admission.
  
  
  RESULTS
  Of 9863 admissions, there were 8912 patients discharged home, of which 1419 were readmitted (14.2%). Unadjusted mortality rate was 2.6%. Most common indications for readmission were cardiac (pericardial disease, atrial fibrillation, heart failure) and infectious (postoperative infection, endocarditis). On multivariable analysis, female gender (adjusted odds ratio [AOR] 1.1; P = .05), black race (AOR 1.2; P = .05), median income <$40,000 (AOR 1.3; P = .01), government-sponsored insurance (AOR 1.4; P < .001), renal insufficiency (AOR 2.1; p < .001), Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) 3 complexity (AOR 1.3; P = .04), and emergent admissions (AOR 1.5 P < .001) were risk factors for readmission.
  
  
  CONCLUSIONS
  One out of seven adult congenital heart surgery hospitalizations results in unplanned readmission. Female gender, lower income status, black race, government-sponsored insurance, renal failure, unscheduled index admission, and RACHS-1 three surgical procedures are risk factors for subsequent unplanned 30-day readmission. These risk factors may serve as potential quality improvement targets to reduce readmissions.
authors.affiliation: Divisions of Cardiology, Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Yuli Y
authors.initials: YY
authors.lastname: Kim
authors.affiliation: Division of Pediatric Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: Division of Cardiothoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
authors.affiliation: Division of Pediatric Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Benavidez
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007182:Income; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: congenital; heart defects; readmission; risk factors; surgery