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J Thorac Cardiovasc Surg 1999;118:823-832
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

READMISSION AFTER CARDIAC OPERATIONS: PREVALENCE, PATTERNS, AND PREDISPOSING FACTORS

From the Departments of Cardiothoracic Surgery and Biostatistics, Lahey Clinic Medical Center, Burlington Mass.

Address for reprints: Richard S. D’Agostino, MD, Department of Cardiothoracic Surgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA 01805 (E-mail:Richard.S.D'Agostino{at}Lahey.org).

Objectives: This study was undertaken (1) to determine the prevalence of hospital readmission within 1 month of discharge after cardiac operations, (2) to categorize diagnoses responsible for readmission, and (3) to examine predischarge patient factors that influenced readmission.
Methods: Data at 1 month after discharge were obtained for 1665 (98.4%) of 1692 patients who underwent cardiac operations between January 1996 and July 1998.
Results: Two hundred twenty-five patients (13.5%) were readmitted to a hospital within a 1-month period after discharge. Forty-eight percent of readmissions were to other hospitals. The most common readmission problems were congestive heart failure (15.6%), atrial fibrillation (12.9%), chest pain (12.0%), wound problems (10.2%), and gastrointestinal problems (8.0%). Hospital discharge on or before the fifth postoperative day was associated with a lower prevalence of subsequent readmission. The independent predictors of a readmission for congestive heart failure were postoperative stay longer than 5 days, diabetes, New York Heart Association functional class IV, preoperative congestive heart failure, total blood product use, the need for postoperative inotropes, body mass index greater than 28 kg/m², and reoperation for bleeding.
Conclusions: The prevalence of rehospitalization during the first month after discharge is not trivial. Other than postoperative atrial fibrillation, readmission is probably the single most likely adverse event to befall a patient in the early postoperative period. Patients who are discharged early do not appear to be at increased risk. Patterns in readmission diagnoses suggest opportunities for preventive strategies.

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