Abstract
BackgroundReadmission 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.MethodsWe 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.ResultsIn 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.ConclusionsNearly 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.
Highlights
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
Study selection We included studies identified by the systematic search in the review if they met all of the following criteria: (1) study population: adult patients undergoing CABG, irrespective of indication, severity of disease, and whether carried out as an isolated procedure or in combination with other cardiac surgeries; (2) study design: observational studies; (3) outcome: hospital readmissions within 30 days of CABG surgery, irrespective of cause of readmission; (4) comparison or control group: none; (5) article type: original research articles published in peerreviewed journals; and (6) language: written in English
Most of the included studies in this systematic review are from the United States of America (USA) [7, 8, 11,12,13,14, 20,21,22,23,24,25,26, 28,29,30,31,32,33,34,35,36,37, 39,40,41,42,43,44, 46,47,48,49, 52, 54, 58, 59, 62, 64, 65] and we found that these studies had higher rates of 30-day readmission (13.6% vs. 10.5%) than studies conducted outside the USA
Summary
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. The annual volume and population-based rate of coronary artery bypass graft (CABG) surgery have declined significantly over the past two decades in the United States of America (USA) and in other developed countries [1,2,3,4]. While reduction of unplanned readmissions in patients undergoing CABG is a clinical priority, the 30-day risk-standardised unplanned readmission rate following CABG is considered in the Hospital Readmissions Reduction Program (HRRP) in the USA, which penalizes hospitals financially for above-expected rates [10]. Given these significant clinical and policy implications, it is important to identify and address factors driving unplanned readmissions following CABG
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