Open Access

ARTICLE

Readmissions after adult congenital heart surgery: Frequency and risk factors

Yuli Y. Kim¹, Wei He², Thomas E. MacGillivray³, Oscar J. Benavidez²

1 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
2 Division of Pediatric Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
3 Division of Cardiothoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

* Corresponding Author: Oscar J. Benavidez, MD, Division of Pediatric/Congenital Cardiology, Department of Pediatrics, Massachusetts General Hospital, 175 Cambridge Street, Suite 510, Boston, MA 02114, USA. Email:

Congenital Heart Disease 2017, 12(2), 159-165. https://doi.org/10.1111/chd.12433

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.
Design: Retrospective cohort study using State Inpatient Databases for Washington, New York, Florida, and California from 2009 to 2011.
Setting: Federal and nonfederal acute care hospitals.
Patients: Admissions of patients age 18–49 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating adult congenital heart surgery.
Outcome Measures: 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), governmentsponsored 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.

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