Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost: insights from the Nationwide Readmission Database
Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost: insights from the Nationwide Readmission Database
Objectives: This study aimed to examine the 30-day unplanned readmissions rate, predictors of readmission, causes of readmissions, and clinical impact of readmissions after percutaneous coronary intervention (PCI).
Background: Unplanned rehospitalizations following PCI carry significant burden to both patients and the local health care economy and are increasingly considered as an indicator of quality of care.
Methods: Patients undergoing PCI between 2013 and 2014 in the U.S. Nationwide Readmission Database were included. Incidence, predictors, causes, and cost of 30-day unplanned readmissions were determined.
Results: A total of 833,344 patients with PCI were included, of whom 77,982 (9.3%) had an unplanned readmission within 30 days. Length of stay for the index PCI was greater (4.7 vs. 3.9 days) and mean total hospital cost ($23,211 vs. $37,524) was higher for patients who were readmitted compared with those not readmitted. The factors strongly independently associated with readmissions were index hospitalization discharge against medical advice (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.65 to 2.22), transfer to short-term hospital for inpatient care (OR: 1.62; 95% CI: 1.38 to 1.90), discharge to care home (OR: 1.57; 95% CI: 1.51 to 1.64), and chronic kidney disease (OR: 1.50; 95% CI: 1.44 to 1.55). Charlson Comorbidity Index score (OR: 1.28; 95% CI: 1.27 to 1.29) and number of comorbidities (OR: 1.18; 95% CI: 1.17 to 1.18) were independently associated with unplanned readmission. The majority of readmissions were due to noncardiac causes (56.1%).
Conclusions: Thirty-day readmissions after PCI are relatively common and relate to baseline comorbidities and place of discharge. More than one-half of the readmissions were due to noncardiac causes.
cost, percutaneous coronary intervention, predictors, readmission
665-674
Kwok, Chun Shing
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Rao, Sunil V.
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Potts, Jessica E.
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Kontopantelis, Evangelos
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Rashid, Muhammad
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Kinnaird, Tim
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Curzen, Nick
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Nolan, James
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Bagur, Rodrigo
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Mamas, Mamas A.
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9 April 2018
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Rao, Sunil V.
482cea66-8ca9-43bd-80c4-fefc0ad466fb
Potts, Jessica E.
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Kontopantelis, Evangelos
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Rashid, Muhammad
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Kinnaird, Tim
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Curzen, Nick
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Nolan, James
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Bagur, Rodrigo
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Mamas, Mamas A.
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Kwok, Chun Shing, Rao, Sunil V., Potts, Jessica E., Kontopantelis, Evangelos, Rashid, Muhammad, Kinnaird, Tim, Curzen, Nick, Nolan, James, Bagur, Rodrigo and Mamas, Mamas A.
(2018)
Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost: insights from the Nationwide Readmission Database.
JACC: Cardiovascular Interventions, 11 (7), .
(doi:10.1016/j.jcin.2018.01.248).
Abstract
Objectives: This study aimed to examine the 30-day unplanned readmissions rate, predictors of readmission, causes of readmissions, and clinical impact of readmissions after percutaneous coronary intervention (PCI).
Background: Unplanned rehospitalizations following PCI carry significant burden to both patients and the local health care economy and are increasingly considered as an indicator of quality of care.
Methods: Patients undergoing PCI between 2013 and 2014 in the U.S. Nationwide Readmission Database were included. Incidence, predictors, causes, and cost of 30-day unplanned readmissions were determined.
Results: A total of 833,344 patients with PCI were included, of whom 77,982 (9.3%) had an unplanned readmission within 30 days. Length of stay for the index PCI was greater (4.7 vs. 3.9 days) and mean total hospital cost ($23,211 vs. $37,524) was higher for patients who were readmitted compared with those not readmitted. The factors strongly independently associated with readmissions were index hospitalization discharge against medical advice (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.65 to 2.22), transfer to short-term hospital for inpatient care (OR: 1.62; 95% CI: 1.38 to 1.90), discharge to care home (OR: 1.57; 95% CI: 1.51 to 1.64), and chronic kidney disease (OR: 1.50; 95% CI: 1.44 to 1.55). Charlson Comorbidity Index score (OR: 1.28; 95% CI: 1.27 to 1.29) and number of comorbidities (OR: 1.18; 95% CI: 1.17 to 1.18) were independently associated with unplanned readmission. The majority of readmissions were due to noncardiac causes (56.1%).
Conclusions: Thirty-day readmissions after PCI are relatively common and relate to baseline comorbidities and place of discharge. More than one-half of the readmissions were due to noncardiac causes.
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Accepted/In Press date: 9 January 2018
e-pub ahead of print date: 2 April 2018
Published date: 9 April 2018
Keywords:
cost, percutaneous coronary intervention, predictors, readmission
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Local EPrints ID: 422501
URI: http://eprints.soton.ac.uk/id/eprint/422501
ISSN: 1936-8798
PURE UUID: 98903f9e-b3c1-423b-b378-2584fa139d1c
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Date deposited: 24 Jul 2018 16:31
Last modified: 16 Mar 2024 03:45
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Contributors
Author:
Chun Shing Kwok
Author:
Sunil V. Rao
Author:
Jessica E. Potts
Author:
Evangelos Kontopantelis
Author:
Muhammad Rashid
Author:
Tim Kinnaird
Author:
James Nolan
Author:
Rodrigo Bagur
Author:
Mamas A. Mamas
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