Nearly one in eight coronary artery bypass graft (CABG) patients are readmitted within 30 days of their procedure, the majority of which are readmitted for non-cardiac causes. This is according to a systematic review and meta-analysis of readmission after CABG published in the Journal of Cardiothoracic Surgery.
The analysis, conducted by Md Shajedur Rahman Shawon (Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia) aimed to quantify rates of readmission within 30 days of CABG surgery, as well as exploring the causes of readmissions, and investigating how patient- and hospital-level factors influence readmission.
Shawon and colleagues conducted systematic searches of the PubMed and Embase databases to retrieve observational studies investigating readmission after CABG. Random effect meta-analysis was used to estimate rates and predictors of 30-day post-CABG readmission.
The analysis drew data from a total of 53 studies, which included data from 8,937,457 patients. The pooled 30-day readmission rate reported was 12.9% (95% CI: 11.3–14.4%).
Shawon and colleagues found that the most frequently reported underlying causes of 30-day readmissions were infection and sepsis (range: 6.9–28.6%), cardiac arrhythmia (4.5–26.7%), congestive heart failure (5.8–15.7%), respiratory complications (1–20%) and pleural effusion (0.4–22.5%).
Individual factors including age (OR per 10-year increase 1.12 [95% CI: 1.04–1.20]), female sex (OR 1.29 [1.25–1.34]), non-White race (OR 1.15 [1.10–1.21]), not having private insurance (OR 1.39 [1.27–1.51]) and various comorbidities were strongly associated with 30-day readmission rates, whereas associations with hospital factors including hospital CABG volume, surgeon CABG volume, hospital size, hospital quality and teaching status were inconsistent.
The study’s authors write that they did not observe any appreciable differences in readmission rates by publication year, despite significant changes over time in the risk profile and clinical presentation in patients undergoing CABG, and reductions in post-surgery length of stay.
They write that collectively the majority of readmissions after CABG are due to non-cardiac causes, including but not limited to infections, pleural effusion, respiratory complications, gastrointestinal complications and bleeding.
In conclusion, Shawon and colleagues write, “30-day readmission rates are strongly influenced by patients’ demographic and clinical characteristics, but not by broadly defined hospital characteristics. The findings of this study are valuable for benchmarking quality improvement in clinical care as well as informing hospital readmission reduction policies for CABG.”