Risk Calculator to Predict 30-Day Readmission After Coronary Artery Bypass: A Strategic Decision Support Tool

Salil V. Deo, Sajjad Raza, Salah E. Altarabsheh, Vaishali S. Deo, Yakov E. Elgudin, Shayan Marsia, Stephen Mitchell, Carolyn Chang, Ankur Kalra, Sahil Khera, Dhaval Kolte, Marco Costa, Daniel Simon, Alan H. Markowitz, Soon J. Park, Joseph F. Sabik

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background: Re-admission is an important source of patient dissatisfaction and increased hospital costs. A simple calculator to determine the probability of re-admission may help guide patient dismissal planning. Methods: Using the national readmissions database (NRD), we identified admissions for isolated primary coronary artery bypass (CABG) and stratified them according to 30-day readmission. Including pre, intra and postoperative variables, we prepared a logistic regression model to determine the probability for re-admission. The model was tested for reliability with boot-strapping and 10-fold cross-validation. Results: From 135,699 procedures, 19,355 were readmitted at least once within 30 days of dismissal. Patients who were readmitted were older (67 ± 10 vs 65 ± 10 years, p <0.01), females (32% vs 24%; p < 0.01) and had a higher Elixhauser comorbidity score (1.5 ± 1.4 vs 1.1 ± 1.2; p < 0.01). Our final model (c- statistic = 0.65) consisted of 16 pre and three postoperative factors. End-stage renal disease (OR 1.79 [1.57–2.04]) and length of stay > 9 days (OR 1.60 [1.52–1.68]) were most prominent indicators for readmission. Compared to Medicaid beneficiaries, those with private insurance (OR 0.62 [0.57–0.68]) and Medicare (OR 0.85 [0.79–0.92]) coverage were less likely to be readmitted. Conclusions: Our simple 30-days CABG readmission calculator can be used as a strategic tool to help reduce readmissions after coronary artery bypass surgery.

Original languageEnglish
Pages (from-to)1896-1903
Number of pages8
JournalHeart Lung and Circulation
Volume28
Issue number12
DOIs
Publication statusPublished - Dec 2019
Externally publishedYes

Keywords

  • Coronary artery bypass grafting
  • Readmission
  • Risk calculator

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