Unplanned hospital readmissions following congenital heart diseases surgery. Prevalence and predictors

Ahmad S. Azhar

Abstract


Objectives:  To estimate the rate of unplanned hospital readmission following surgical repair of congenital heart defects (CHD) and investigate the related causes and risk factors.

Methods: A retrospective chart review of all the patients who underwent surgical repair of CHD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study outcome consisted of any hospital admission during the 12 months following the first reparative surgery. Exclusion criteria included planned admissions. Patients’ demographic and readmission data as well as the perioperative data were collected and analyzed as factors and predictors of unplanaed readmission.

Results: After the exclusion of the deceased patients, a total of 189 patients were included. The readmission rate was 15.9% during a one-year period following surgery. There was a significant association between the probability of readmission and preoperative mechanical ventilation (MV) (p less than 0.001), intraoperative complications (p=0.025), prolonged postoperative length of stay (LOS) (p less than 0.001), early postoperative complication (p=0.007), long postoperative MV stay, and drain tube stay (p=0.011). Significant predictors of unplanned readmission included young age (1-12 months) and low weight at surgery (less than 5kg), preoperative MV, intraoperative complications, postoperative LOS ≥10 days, pediatric intensive care unit stay, MV stay, drain tube stay, infections, respiratory complication, and feeding problems. Only the preoperative MV and LOS greater than 10 days were the independent risk factors.

Conclusion: Readmission rates were similar to those reported in other studies. Future studies are warranted to investigate suitable actions to alleviate the modifiable risk factors, such as postoperative complications. 


Keywords


Congenital heart disease; surgery; readmission; perioperative complication

Full Text:

PDF

References


Fahed AC, Gelb BD, Seidman J, Seidman CE. Genetics of congenital heart disease: the glass half empty. Circ Res 2013; 112: 707-720.

Wren C. The epidemiology of cardiovascular malformations. In: Moller J, Hoffman J, Benson D, van Hare G, Wren C, editors. Pediatric Cardiovascular Medicine. Oxford (UK): Wiley-Blackwell; 2012. p. 268-275.

Hoffman JI. The global burden of congenital heart disease. Cardiovasc J Afr 2013; 24: 141-145.

Alqurashi M, El Mouzan M, Al Herbish A, Al Salloum A, Al Omer A. Symptomatic congenital heart disease in the Saudi Children and Adolescents Project. Ann Saudi Med 2007; 27: 442-444.

Al-Mesned A, Al Akhfash AA, Sayed M. Incidence of severe congenital heart disease at the province of Al-Qassim, Saudi Arabia. Congenit Heart Dis 2012; 7: 277-282.

Greer W, Sandridge A, Al-Menieir M, Al Rowais A. Geographical distribution of congenital heart defects in Saudi Arabia. Ann Saudi Med 2005; 25: 63-69.

Guleserian KJ. Adult congenital heart disease: surgical advances and options. Prog Cardiovasc Dis 2011; 53: 254-264.

Redžek A, Mironicki M, Gvozdenović A, Petrović M, Čemerlić-Ađić N, Ilić A, et al. Predictors for hospital readmission after cardiac surgery. J Card Surg 2015; 30: 1-6.

Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, et al. Pediatric readmission prevalence and variability across hospitals. Jama 2013; 309: 372-380.

Mackie AS, Ionescu-Ittu R, Pilote L, Rahme E, Marelli AJ. Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 2008; 155: 577-584.

Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110-118.

Azhar AS, Aljefri HM. Predictors of Extended Length of Hospital Stay Following Surgical Repair of Congenital Heart Diseases. Pediatr Cardiol 2018; 39:1688-1699.

Saharan S, Legg AT, Armsby LB, Zubair MM, Reed RD, Langley SM. Causes of readmission after operation for congenital heart disease. Ann Thorac Surg 2014; 98: 1667-1673.

Billings J, Dixon J, Mijanovich T, Wennberg D. Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients. BMJ 2006; 333: 327.

Jencks SF, Brock JE. Hospital accountability and population health: lessons from measuring readmission rates. Ann Intern Med 2013; 159: 629-630.

Eghtesady P, Brar AK, Hall M. Prioritizing quality improvement in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2013; 145: 631-640.

Williams DL, Gelijns AC, Moskowitz AJ, Weinberg AD, Ng JH, Crawford E, et al. Hypoplastic left heart syndrome: valuing the survival. J Thorac Cardiovasc Surg 2000; 119: 720-731.

Turley K, Tyndall M, Roge C, Cooper M, Turley K, Applebaum M, et al. Critical pathway methodology: effectiveness in congenital heart surgery. Ann Thorac Surg 1994; 58: 57-65.

Akhtar MI, Hamid M, Minai F, Wali AR. Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a developing country: an observational prospective study. J Anaesthesiol Clin Pharmacol 2014; 30: 355-359.

Kogon B, Jain A, Oster M, Woodall K, Kanter K, Kirshbom P. Risk factors associated with readmission after pediatric cardiothoracic surgery. Ann Thorac Surg 2012; 94: 865-873.

Smith AH, Doyle TP, Mettler BA, Bichell DP, Gay JC. Identifying predictors of hospital readmission following congenital heart surgery through analysis of a multiinstitutional administrative database. Congenit Heart Dis 2015; 10: 142-152.

Vricella LA, Dearani JA, Gundry SR, Razzouk AJ, Brauer SD, Bailey LL. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg 2000; 69: 865-871.

Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC. Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg 2004; 78: 1972-1978.

Gupta P, Rettiganti M, Gossett JM, Yeh JC, Jeffries HE, Rice TB, et al. Risk factors for mechanical ventilation and reintubation after pediatric heart surgery. J Thorac Cardiovasc Surg 2016; 151: 451-458.

Islam S, Yasui Y, Kaul P, Mackie AS. Hospital readmission of patients with congenital heart disease in Canada. Can J Cardiol 2016; 32: 987.

Mascio CE, Wayment M, Colaizy TT, Mahoney LT, Burkhart HM. The modified Fontan procedure and prolonged pleural effusions. Am Surg 2009; 75: 175-177.

Border WL, Syed AU, Michelfelder EC, Khoury P, Uzark KC, Manning PB, et al. Impaired systemic ventricular relaxation affects postoperative short-term outcome in Fontan patients. J Thorac Cardiovasc Surg 2003; 126: 1760-1764.

Pike NA, Okuhara CA, Toyama J, Gross BP, Wells WJ, Starnes VA. Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol. J Thorac Cardiovasc Surg 2015; 150: 481-487.

Sen AC, Morrow DF, Balachandran R, Du X, Gauvreau K, Jagannath BR, et al. Postoperative infection in developing world congenital heart surgery programs: Data from the International Quality Improvement Collaborative. Circ Cardiovasc Qual Outcomes 2017; 10: e002935.

Björ O, Bråbäck L. A retrospective population based trend analysis on hospital admissions for lower respiratory illness among Swedish children from 1987 to 2000. BMC Public Health 2003; 3: 22.


Refbacks

  • There are currently no refbacks.




Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.