Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database)

Chun Shing Kwok,Sara C Martinez,Nick Curzen,Mohamed Mohamed,Mamas A Mamas,Jessica Potts,Khaled Al-Shaibi,Waqar Ahmed,Samir Pancholy,Evangelos Kontopantelis

doi:10.1038/s41598-018-29303-y

Abstract

It is unclear how comorbidity influences rates and causes of unplanned readmissions following percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014. The comorbidity burden as defined by the Charlson Comorbidity Index (CCI). Primary outcomes were 30-day readmission rates and causes of readmission according to comorbidity burden. A total of 2,294,346 PCI procedures were included the analysis. The patients in CCI = 0, 1, 2 and ≥3 were 842,272(36.7%), 701,476(30.6%), 347,537(15.1%) and 403,061(17.6%), respectively. 219,227(9.6%) had an unplanned readmission within 30 days and rates by CCI group were 6.6%, 8.6%, 11.4% and 15.9% for CCI groups 0, 1, 2 and ≥3, respectively. The CCI score was also associated with greater cost (cost of index PCI for not readmitted vs readmitted was CCI = 0 $21,257 vs $19,764 and CCI ≥ 3 $26,736 vs $27,723). Compared to patients with CCI = 0, greater CCI score was associated with greater independent odds of readmission (CCI = 1 OR 1.25(1.22–1.28), p < 0.001, CCI ≥ 3 OR 2.08(2.03–2.14), p < 0.001). Rates of non-cardiac causes for readmissions increased with increasing CCI group from 49.4% in CCI = 0 to 57.1% in CCI ≥ 3. Rates of early unplanned readmission increase with greater comorbidity burden and non-cardiac readmissions are higher among more comorbid patients.

Highlights

Estimate prognosis in patients with multiple coexisting illness with a broad range of cardiovascular diseases[6]
No major changes in readmissions rates were observed over time and the readmission rate for Charlson Comorbidity Index (CCI) ≥ 3 ranged between 15.8% and 16.4%
Comorbidity burden in patients who undergo percutaneous coronary intervention (PCI) is associated with different rates of early unplanned readmissions and is associated with prolonged length of stay in hospital, increased hospital cost, and greater mortality during the readmission episode

Summary

Introduction

Estimate prognosis in patients with multiple coexisting illness with a broad range of cardiovascular diseases[6]. CCI has been shown to be an important independent predictor of adverse outcomes following PCI, with previous studies reporting an association between CCI and cardiac death, major adverse cardiovascular events, major bleeding, and stent thrombosis in the setting of PCI2,4,8. Whilst comorbidity burden (as measured by CCI) has been shown to be predictive of unplanned readmission following emergency general surgery[11], orthopaedic surgery[12] and in general hospital readmissions[13], previous work that has studied unplanned readmissions post-PCI has not considered whether there is an association between comorbid burden and the rates or causes of such readmissions. The objective of the current study is to evaluate the comorbidity burden as defined by the CCI and its impact on the rates and causes of 30-day unplanned readmissions after PCI in an unselected national cohort

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Methods

Results

Conclusion