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Readmissions after cardiac surgery similar despite day of discharge
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Readmission rates after major cardiac surgery were consistent regardless of the date of discharge, researchers reported in the Annals of Thoracic Surgery.
“Though the validity of hospital readmission rate as a quality improvement indicator has been debated, several studies have shown that rehospitalization negatively impacts patient’s quality of life and has contributed to increased complications. Thus, our team was interested in investigating modifiable factors in the discharge process to reduce patient rehospitalization after major cardiac surgery,” Yas Sanaiha, MD, general surgery resident in the Cardiac Outcomes Research Laboratory, division of cardiac surgery, David Geffen School of Medicine at UCLA, told Cardiology Today. “One component of the discharge process was day of discharge, which we decided to study given the body of literature describing the ‘weekend effect,’ which describes the phenomenon of worse outcomes after admissions for heart attack, stroke, sepsis, etc. on weekends, after hours and holidays. This effect has been attributed to decreased staffing and increased transitions of care. The aim of the current study was to evaluate whether this weekend effect also applied to the discharge process, which is an equally resource-intensive phase of hospitalization that requires medical providers to be familiar with a patient and family’s needs.”
Sanaiha and colleagues analyzed 4,877 patients (52% aged 65 years; 66% men) discharged from UCLA after major cardiac surgery between 2008 and 2016, of whom 20% were discharged on a weekend or holiday. Emergency, transplant and mechanical assist procedures were excluded.
Readmission rates
The primary outcome was 30-day all-cause readmission. The researchers also identified predictors of 30-day readmission.
The 30-day readmission rate was 11.3% in the overall cohort and did not significantly differ between the weekday group and the weekend/holiday group (11.4% vs. 10.9%, respectively; P = .73), according to the researchers.
Discharge to a facility instead of to home was more common in the weekday group (15% vs. 5.7%; P < .001) and was associated with higher unadjusted all-cause readmissions (16.7% vs. 12.7%; P = .01), they wrote.
After adjustment for patient comorbidities, operative performance and postoperative complications, there was no difference between the groups in readmission performance (adjusted OR = 1; 95% CI, 0.77-1.32).
“Readmissions for arrhythmia/heart block were the most common reasons for readmission, while pericardial effusion ... resulted in 4% of readmissions,” Sanaiha told Cardiology Today. “Increased risk of readmission for patients with active smoking and depressed ejection fraction (preoperative heart failure) are additional factors that warrant increased emphasis on tobacco cessation and heart failure optimization. We would encourage clinicians to proceed with weekend/holiday discharges as long as a system for readmission reduction is in place, appointments are made and medications are dispensed regardless of the time of the week.
“The increased odds of readmission with preoperative beta-blockers was also initially surprising to us, but likely reflects the fact that these patients had significant cardiovascular disease preoperatively,” she said.
Advance planning
Successful weekend/holiday discharge requires prior planning, Sanaiha said.
“We hope that our study will impact future hospital discharge processes in two ways,” she told Cardiology Today. “First, we hope that our study encourages other institutions to perform early, longitudinal and multidisciplinary discharge planning as has been adopted in our institution rather than investing in independent resource allocation to isolated staff for weekend discharges. We also hope that institutions have decreased hesitancy to discharge patients on weekends, only to wait until a weekday/nonholiday to optimize the flow of patients through often overcrowded hospital wards.” – by Erik Swain
For more information:
Yas Sanaiha, MD, can be reached at ysanaiha@mednet.ucla.edu; Twitter: @YasSanaiha.
Disclosure: Sanaiha reports no relevant financial disclosures.
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