Why the study?
It is unclear how pre-surgery transfer relates to readmission destination after cardiac surgery and whether readmission to a non-operating hospital is associated with increased mortality.
Does emergency readmission to a non-index hospital increase 30-day all-cause mortality compared to readmission to the index operating hospital in adults undergoing CABG or surgical valve replacement?
Does emergency readmission to a non-index hospital increase 30-day all-cause mortality compared to readmission to the index operating hospital in adults undergoing CABG or surgical valve replacement?
In an Australian population-based cohort, 72.2% of patients readmitted within 30 days after cardiac surgery went to a non-operating hospital, but readmission to a non-index hospital was not associated with increased 30-day or 1-year mortality.
Answers are grounded in this paper and cite their sources.
No mortality difference seen with non-index readmission after cardiac surgery; leaves open causality and need for prospective studies on other outcomes.
Background: It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality. Methods: We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003-2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer. Findings: Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75-1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75-1.52; transfer: aOR = 0.88, 95% CI 0.45-1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50-2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33-1.48). Interpretation: Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality. Funding: This study was funded by a National Health and Medical Research Foundation of Australia (NHMRC) Project Grant (#1162833).
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Shawon et al. (2024) studied this question.
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