Original article
Pediatric cardiac
Risk Factors Associated With Readmission After Pediatric Cardiothoracic Surgery

https://doi.org/10.1016/j.athoracsur.2012.04.025Get rights and content

Background

Approximately 10% to 20% of children are readmitted congenital heart surgery. Readmissions are now being viewed by payers as preventable complications of the original surgery or hospitalization, and there have been proposals by insurance agencies to deny coverage of the additional expenses incurred by the readmission. With hopes to reduce the potential impact, we analyzed patients undergoing congenital heart surgery at our institution in order to identify risk factors for readmission.

Methods

We performed a retrospective cohort study of 685 patients who underwent congenital heart surgery at Children's Healthcare of Atlanta between January 1, 2009 and December 31, 2009, and were subsequently discharged. Readmission was defined as an admission within 30 days discharge. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate comparisons were made between the readmission and non-readmission groups, and multivariate Poisson regression analysis was performed to identify potential risk factors for readmission.

Results

There were 74 readmissions in 70 patients. Reasons for readmission included effusive, pleural or pericardial (19, 26%), gastrointestinal (18, 24%), respiratory (4, 5%), infectious (14, 19%), cardiac (11, 15%), and other (8, 11%) complications. In comparisons between readmitted and non-readmitted patients, significant demographic variables included younger age, lower weight, and Hispanic ethnicity in the readmitted group. Significant preoperative variables included genetic anomaly, failure to thrive, and mechanical ventilation. Significant operative variables included risk-adjusted congenital heart surgery score, and significant postoperative variables included nasogastric feeds at discharge, palliated cardiac physiology, longer intensive care unit stay, and longer hospital stay. In multivariate analysis, Hispanic ethnicity (relative risk [RR] 1.86; 95% confidence interval [CI] 1.10 to 3.12; p = 0.019], preoperative failure to thrive (RR 2.88; 95% CI 1.53 to 5.40; p = 0.001), and length of stay greater than 10 days (RR 4.24; 95% CI 2.26 to 7.96; p < 0.001) were significant risk factors for readmission.

Conclusions

Potential risk factors for readmission after congenital heart surgery have been identified. Hopefully, altering the discharge process and the early postoperative care in these high-risk patients can minimize the impact of hospital readmissions after congenital heart surgery.

Section snippets

Material and Methods

After obtaining Internal Review Board approval, we performed a retrospective cohort study of 685 patients who underwent congenital heart surgery at Children's Healthcare of Atlanta at Egleston between January 1, 2009 and December 31, 2009 and were subsequently discharged. Readmission was defined as a repeat admission to Egleston occurring within 30 days discharge.

Population Summary Statistics

For the entire cohort, median age was 198 days (range 1 to 7,531) and median weight was 6.4 kg (range 1.7 to 102.1). There was a slight male predominance (57% vs 43%) and most of our patients were Caucasian (49%). The most common preoperative histories were the presence of a genetic anomaly (103, 15%) and gastroesophageal reflux disease (106, 15%) (Table 1).

When categorized by the risk-adjusted congenital heart surgery method, 80 patients (12%) were RACHS 1, 256 (37%) RACHS 2, 204 (30%) RACHS

Comment

Readmission to the hospital shortly after discharge appears to be a problem across all ages and all service lines. With proposals by insurance companies to deny coverage of the additional expenses incurred by the readmission, there is increasing attention being paid to these particular patients [2].

Many studies have examined readmission in children with asthma and other chronic medical conditions [3, 4, 5, 6, 7]. Unfortunately, there is very little information available regarding readmission

References (15)

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