Key result
Unplanned cardiac readmission occurred in 37% of patients within 180 days after open-heart valve surgery, with specific patient characteristics predicting cause-specific readmissions.
Why the study?
The causes of early (≤30 days) versus late (31-180 days) readmission and the characteristics associated with overall and cause-specific readmission after open-heart valve surgery needed description.
Cohort (n=980)
No
Unplanned cardiac readmissions after open-heart valve surgery are common (37% at 180 days) and driven by diverse, cause-specific risk factors rather than universal predictors.
May warrant enhanced post-discharge surveillance after valve surgery; leaves open optimal strategies to mitigate cause-specific readmissions.
OBJECTIVES: The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause-specific readmissions after open-heart valve surgery. METHODS: A single-center, retrospective cohort of 980 patients undergoing open-heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause-specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18-2.88), male gender (HR: 1.85; CI: 1.11-3.09), high alcohol intake (HR: 1.99; CI: 1.22-3.24) and mitral valve procedures (HR: 1.86; CI: 1.11-3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53-5.63), mitral valve procedures (HR: 2.10; CI: 1.23-3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03-2.85) were associated with atrial fibrillation/flutter readmissions. CONCLUSION: Predicting overall readmissions after open-heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause-specific readmissions.
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Weiss et al. (2020) conducted a cohort in open-heart valve surgery (n=980). Patient characteristics was evaluated on unplanned cardiac readmission within 180 days after discharge. Unplanned cardiac readmission occurred in 37% of patients within 180 days after open-heart valve surgery, with specific patient characteristics predicting cause-specific readmissions.
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