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Mary A, Mzayek F, Lefler LL, Jiang YJ, Meadows Taylor M. Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery. Prof Case Manag 2024:01269241-990000000-00015. [PMID: 38421737 DOI: 10.1097/ncm.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF STUDY Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. PRIMARY PRACTICE SETTINGS The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. METHODOLOGY AND SAMPLE A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery. RESULTS The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.
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Affiliation(s)
- Annapoorna Mary
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Fawaz Mzayek
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Leanne L Lefler
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Yu Joyce Jiang
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Meghan Meadows Taylor
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
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Sparrow RT, Sposato LA, Alkhouli MA, García S, Elgendy IY, Kuchtaruk AA, Jneid H, Alraies MC, Tzemos N, Mamas MA, Bagur R. Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack. CJC Open 2023; 5:950-964. [PMID: 38204857 PMCID: PMC10774085 DOI: 10.1016/j.cjco.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 01/12/2024] Open
Abstract
Background We examined the frequency and risk factors associated with readmission after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke and/or transient ischemic attack (TIA). Methods Hospitalizations for LAAC were identified from the US National Readmission Database, 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into those occurring within 0 to 30 days vs within 31 to 180 days. Patients were stratified based on the history of previous stroke and/or TIA. Results Of 12,901 discharges after LAAC, 28% had previous stroke and/or TIA, and 8.2% had a readmission within 30 days while 18% had a readmission within 31 to 180 days. The rates of in-hospital complications and readmissions at both periods were not significantly different between individuals with vs without previous stroke and/or TIA. Cardiac causes accounted for 28% of readmissions within 30 days and 32% of those within 31 to 180 days, and congestive failure, bleeding, and infections were the most common readmission diagnoses. New stroke and/or TIA accounted for 4% and 6% of the total noncardiac readmissions within 30 days and 31 to 180 days, respectively, and the incidence was higher among those with previous stroke and/or TIA. Female sex and index hospitalization length of stay (LOS) > 1 day were factors independently associated with readmission within 30 days, whereas LOS, diabetes, renal disease, chronic obstructive pulmonary disease, and anemia were among the factors associated with readmissions within 31 to 180 days. Conclusions Unplanned rehospitalizations were common after LAAC and had similar frequency for patients with vs without previous ischemic stroke and/or TIA. Female sex and index hospitalization LOS > 1 day were among the strongest factors that were independently associated with readmission within 30 days.
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Affiliation(s)
- Robert T. Sparrow
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Luciano A. Sposato
- London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Stroke, Dementia & Heart Disease Laboratory, Kathleen and Dr Henry Barnett Chair in Stroke Research, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamad A. Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Santiago García
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | | | - Hani Jneid
- Division of Cardiology, Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - M. Chadi Alraies
- Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Nikolaos Tzemos
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16:172. [PMID: 34112216 PMCID: PMC8194115 DOI: 10.1186/s13019-021-01556-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/30/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Readmission after coronary artery bypass graft (CABG) surgery is associated with adverse outcomes and significant healthcare costs, and 30-day readmission rate is considered as a key indicator of the quality of care. This study aims to: quantify rates of readmission within 30 days of CABG surgery; explore the causes of readmissions; and investigate how patient- and hospital-level factors influence readmission. METHODS We conducted systematic searches (until June 2020) of PubMed and Embase databases to retrieve observational studies that investigated readmission after CABG. Random effect meta-analysis was used to estimate rates and predictors of 30-day post-CABG readmission. RESULTS In total, 53 studies meeting inclusion criteria were identified, including 8,937,457 CABG patients. The pooled 30-day readmission rate was 12.9% (95% CI: 11.3-14.4%). The most frequently reported underlying causes of 30-day readmissions were infection and sepsis (range: 6.9-28.6%), cardiac arrythmia (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. CONCLUSIONS Nearly 1 in 8 CABG patients are readmitted within 30 days and the majority of these are readmitted for noncardiac causes. Readmission rates are strongly influenced by patients' demographic and clinical characteristics, but not by broadly defined hospital characteristics.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- Centre for Big Data Research in Health, University of New South Wales (UNSW) Sydney, Kensington, Australia.
| | - Michael Odutola
- Centre for Big Data Research in Health, University of New South Wales (UNSW) Sydney, Kensington, Australia
| | - Michael O Falster
- Centre for Big Data Research in Health, University of New South Wales (UNSW) Sydney, Kensington, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales (UNSW) Sydney, Kensington, Australia
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Son YJ, Lee HJ, Lim SH, Hong J, Seo EJ. Predictors of unplanned 30-day readmissions after coronary artery bypass graft: a systematic review and meta-analysis of cohort studies. Eur J Cardiovasc Nurs 2021; 20:717-725. [PMID: 33864067 DOI: 10.1093/eurjcn/zvab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Coronary artery bypass graft (CABG) is one of the most performed cardiac surgery globally. CABG is known to have a high rate of short-term readmissions. The 30-day unplanned readmission rate as a quality measure is associated with adverse health outcomes. This study aimed to identify and synthesize the perioperative risk factors for 30-day unplanned readmission after CABG. METHODS AND RESULTS We systematically searched seven databases and reviewed studies to identify all eligible English articles published from 1 October 1999 to 30 September 2019. Random-effect models were employed to perform pooled analyses. Odds ratio and 95% confidence interval were used to estimate the risk factors for 30-day unplanned readmission. The 30-day hospital readmission rates after CABG ranged from 9.2% to 18.9% in 14 cohort studies. Among preoperative characteristics, older adults, female, weight loss, high serum creatinine, anticoagulant use or dialysis, and comorbidities were found to be statistically significant. Postoperative complications, prolonged length of hospital stay, and mechanical ventilation were revealed as the postoperative risk factors for 30-day unplanned readmission. However, intraoperative risk factors were not found to be significant in this review. CONCLUSION Our findings emphasize the importance of a comprehensive assessment during the perioperative period of CABG. Healthcare professionals can perform a readmission risk stratification and develop strategies to reduce readmission rates after CABG using the risk factors identified in this review. Future studies with prospective cohort samples are needed to identify the personal or psychosocial factors influencing readmission after CABG, including perioperative risk factors.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University, Suwon 16499, Republic of Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, 164, Worldcup-Ro, Yeongtong-Gu, Suwon 16499, Republic of Korea
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