Academic journal article Australian Health Review

Predictors of Readmission after Elective Coronary Artery Bypass Graft Surgery

Academic journal article Australian Health Review

Predictors of Readmission after Elective Coronary Artery Bypass Graft Surgery

Article excerpt

Abstract

Objective: We sought to examine potential predictors of readmission after coronary artery bypass graft (CABG) surgery.

Design/setting: We analysed routinely collected data of CABG patients who have used the public hospital system of Victoria, Australia from July 1998 to June 2003. In total, 6627 patients were selected by linking records of elective surgery waiting time data (Elective Surgery Information System), emergency department data (Victorian Emergency Minimum Dataset) and hospital discharge data (Victorian Admitted Episodes Dataset).

Measurements: The outcome measures were 7-day, 30-day and 6-month readmissions. Possible predictors included were age, gender, Charlson comorbidity index, waiting times, length of stay in the hospital, and frequency of emergency department (ED) visits before CABG surgery.

Results: 7.1%, 15.2%, and 32.3% of the study population were readmitted at 7 days, 30 days and 6 months respectively. In a multivariable regression model Charlson comorbidity index was associated with 30-day (OR=1.18; 95% CI 1.11-1.24; Pā‰¤0.01) and 6-month readmission (OR=1.20; 95% CI 1.15-1.26; P<0.01). Multiple ED visits were associated with 7 day (OR=1.75; 95% CI 1.28-2.38; P<0.01), 30 day (OR=1.53; 95% CI 1.22-1.93; P<0.01) and 6 month (OR=1.80; 95% CI 1.49-2.18; P<0.01) readmission. Waiting time was not a statistically significant predictor of readmission.

Aust Health Rev 2008: 32(4): 677-683

CARDIOVASCULAR HEALTH is an Australian government National Health Priority Area. Coronary heart disease (CHD) is the largest single cause of death in Australia, accounting for 19.5% of deaths in 2002.1 Coronary artery bypass graft (CABG) surgery is a common procedure used in treating patients with CHD. The number of CABG procedures performed in Australia has remained steady between 1995 and 2000, at a little over 17000.2 The number of CABG operations in Victoria performed electively in public hospitals is estimated to have been about 1500 per year between 1998 and 2003. The high number of CABG surgeries performed in Australian settings highlights the importance of investigating the predictors of readmission in Australian settings, as this has not been examined to date.

CABG surgery is associated with a significant risk of mortality and morbidity, including a significant rate of readmissions, which are costly and often preventable.3 An investigation of the predictors of readmission will assist in identifying atrisk patients. The incidence of readmission after CABG surgery has been reported by analysing routinely collected data in some countries.4-6 However, the findings have not been consistent between geographical locations, highlighting the importance of examining this question in specific local settings before any recommendations can be made on the use of these indicators even in a local context.

The data collection of the Victorian Department of Human Services (DHS) reflect public hospital activity across a diverse range of hospitals servicing a state population estimated to be below five million people in December 2003. These data are particularly comprehensive and reliable, as hospitals depend on accurate, timely data provision for their funding and performance monitoring, with the associated penalties and bonuses.7 As the data are collected centrally, there is a standardisation of the data collected and their coding. This allows the derivation of predictors such as the waiting time, the Charlson comorbidity index, and the length of stay (LOS). A linkage of waiting list and hospital morbidity data provides an excellent opportunity to examine the independent associations between routinely collected information and readmissions after CABG surgery.

Methods

Study design

This study is a retrospective cohort study, to analyse the routinely collected data of patients who have had CABG surgery in the public hospital system of Victoria. ā€¦

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