TY  - EJOU
AU  - Kim, Yuli Y. 
AU  - He, Wei 
AU  - MacGillivray, Thomas E. 
AU  - Benavidez, Oscar J. 

TI  - Readmissions after adult congenital heart surgery: Frequency and risk factors
T2  - Structural and Congenital Heart Disease

PY  - 2017
VL  - 12
IS  - 2
SN  - 3071-1738

AB  - <b>Objective:</b> 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.<br/>
<b>Design:</b> Retrospective cohort study using State Inpatient Databases for Washington, New York,
Florida, and California from 2009 to 2011.<br/>
<b>Setting:</b> Federal and nonfederal acute care hospitals.<br/>
<b>Patients:</b> Admissions of patients age 18–49 years with International Classification of Diseases, Ninth
Revision, Clinical Modification codes indicating adult congenital heart surgery.<br/>
<b>Outcome Measures:</b> Readmission was defined as any nonelective hospitalization for a given
patient ≤30 days of discharge from the index congenital heart surgery admission.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.
KW  - heart defects
KW  -  congenital
KW  -  surgery
KW  -  risk factors
KW  -  readmission

DO  - 10.1111/chd.12433