Abstract
Unplanned readmissions to hospital after percutaneous coronary intervention (PCI) pose a significant burden to the healthcare system and are potentially preventable. In this study, we sought to determine the incidence of, and risk factors for, unplanned hospital readmissions within 30 days following PCI. We prospectively collected data on 28,488 patients undergoing PCI between 2013 and 2019, who were enrolled in the state-wide multi-centre Victorian Cardiac Outcomes Registry. Patients’ data were then linked to data from the Victorian Department of Health administrative database that records statewide hospital admissions. Disease diagnosis codes were used to identify cause of readmission. Patients who had an unplanned readmission were further divided into those who had a cardiac vs. non-cardiac cause for readmission. Overall, 3059 patients (10.7%) had an unplanned hospital readmission within 30 days of PCI, of which 1848 patients (60.4%) were readmitted for primarily cardiac diagnoses. Independent predictors of both 30-day unplanned cardiac and non-cardiac readmissions post-PCI were female sex, having ≥1 admission in the 12 months prior to PCI, acute coronary syndrome presentation, having any in-hospital complication and being discharged on an oral anticoagulant (all p < 0.05). A stepwise increase in readmission risk was observed with increasing number of admissions from 1 to ≥4 admissions in the 12 months prior to PCI. In conclusion, a substantial proportion of patients undergoing PCI have unexpected readmissions to hospital in the 30 days following PCI. Targeted strategies for patients with risk factors for readmission may be useful to reduce this significant burden to the healthcare system.
Highlights
Unplanned readmission to hospital is an important problem, which results in a significant burden to the healthcare system and adverse patient outcomes [1,2]
We undertook a retrospective cohort study of all patients undergoing percutaneous coronary intervention (PCI) between 1 January 2013 and 31 December 2017 who were enrolled in the Victorian Cardiac Outcomes Registry (VCOR) PCI module, a multi-centre PCI registry which has previously been described in detail elsewhere [7]
We found that most readmissions were primarily due to cardiac diagnoses
Summary
Unplanned readmission to hospital is an important problem, which results in a significant burden to the healthcare system and adverse patient outcomes [1,2]. Public reporting of hospital unplanned post-PCI readmission rates has been implemented in some health systems [5]. Clinical registries face resource constraints when performing post-discharge follow-up, which can potentially be overcome by linkage to administrative datasets containing routinely collected hospital data. Data linkage to routinely collected administrative data mitigates the potential error from patient under-reporting of hospitalizations and consequent under-estimation of readmission rates encountered by some previous studies. Help to create a richer, more accurate data source from which factors associated with post-discharge events such as readmission can be ascertained. We aimed to link data from a large multi-centre PCI registry to routine hospital datasets to determine the incidence of and factors associated with unplanned hospital readmissions in the first 30 days following PCI
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