Abstract 71: Causes of 30-day Readmission Rates after Percutaneous Coronary Intervention - Lessons from Direct Chart Review

Abstract

Background: Policymakers have designated 30-day readmission after percutaneous coronary intervention (PCI) as an important quality metric. Nevertheless, detailed descriptions of the causes and preventability of readmissions after PCI are lacking, leading some to question the usefulness of readmission as a quality metric. Determination of the causes of 30-day readmissions can help clarify the clinical validity of this measure and enable hospitals to develop strategies to reduce readmission rates. Methods: We identified all readmissions after PCI at the Massachusetts General Hospital occurring within 30 days of discharge from 2007 - 2011. For patients with multiple readmissions, only the first readmission was included. Detailed patient medical record reviews were conducted to ascertain documented reasons for readmission. Results: Among 5573 patients receiving PCI, we identified 651 readmissions within 30 days for medical record review representing 625 unique readmitted patients (11.2%). Of these, 241 readmissions (37.0%) were for the evaluation of chest pain, pressure, or other symptoms concerning for angina without an immediately obvious stent thrombosis. Of those, 21 required repeat PCI (8.7%) and 3 (1.2%) required CABG. Forty patients (6.1%) were readmitted for planned, staged procedures in the absence of new symptoms (“staged PCI”); 18 patients (2.8%) were readmitted non-urgently for peripheral vascular procedures or surgery unrelated to the PCI procedure; 24 patients (3.7%) were admitted for vascular or bleeding complications of the PCI procedure. Conclusions: In this single center study, the largest proportion of readmissions after PCI is due to symptoms that prompt concern for angina, the overwhelming majority of which (90.0%) do not require repeat revascularization. Hospitals may be able to minimize 30-day readmission rates after PCI substantially by postponing non-urgent, non-coronary procedures after PCI. Transferring the evaluation of low-risk chest pain to the outpatient setting or to emergency department observation units could dramatically reduce 30 day readmission rates after PCI. Table 1: Main reason for readmission (N = 651) Chest pain or other symptoms concerning for angina - 238 (36.6%) ** Subset of those patients who received repeat PCI - 21 (3.2%) Staged PCI - 40 (6.1%) Stent thrombosis - 19 (2.9%) Sudden cardiac death - 4 (0.6%) Elective peripheral procedure or surgery not related to PCI - 18 (2.8%) Elective CABG - 14 (2.2%) ** Subset of those patients with failed PCI - 10 (1.5%) ** Subset of those patients with staged CABG after PCI - 4 (0.6%) Vascular/bleeding complication of PCI - 24 (3.7%) Atrial fibrillation - 11 (1.7%) Congestive heart failure - 39 (6.0%) Cholecystitis or cholangitis - 7 (1.1%) Gastrointestinal hemorrhage - 25 (3.8%) Venous thromboembolism - 6 (0.9%) Pneumonia - 10 (1.5%) Urinary tract infection - 9 (1.4%)