Thirty-day Readmissions Among Patients With Cardiogenic Shock Who Underwent Extracorporeal Membrane Oxygenation Support In The United States: Insights From The Nationwide Readmissions Database

Abstract

Background The use of Extracorporeal Membrane Oxygenation (ECMO) for cardiogenic shock has been increasing in the United States and is associated with significant morbidity, mortality, and healthcare resources utilization. We sought to explore rates and predictors of hospital readmissions in patients with cardiogenic shock after contemporary ECMO use. Methods Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who were hospitalized between January to November between 2016-2018 for cardiogenic shock (ICD code R57.0) requiring ECMO support (ICD-10-PCS 5A15223). Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. Results A total of 10,723 patients underwent ECMO for cardiogenic shock from 2016 to 2018. After excluding patients who died (n=5,602; 52%) and those who underwent LVAD or OHT during index admission (n=892; 8%), 4,229 patients discharged alive were included in our analysis. Of those, 694 (16.4%) were re-admitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR=1.77; 95% CI 1.32-2.37), chronic liver disease (OR=1.35; 95% CI 1.03-1.77), and prolonged LOS (≥30 days; OR =1.38; 95% CI 1.05-1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50-0.95) and short-term hospital post discharge care (OR = 0.53; 95% CI 0.28-0.99) conferred a lower risk. Sepsis, followed by congestive heart failure were the more common causes for readmission. Conclusions Proper identification of patients at increased risk for readmission may help improve prevention strategies and improve outcomes of cardiogenic shock after ECMO. The use of Extracorporeal Membrane Oxygenation (ECMO) for cardiogenic shock has been increasing in the United States and is associated with significant morbidity, mortality, and healthcare resources utilization. We sought to explore rates and predictors of hospital readmissions in patients with cardiogenic shock after contemporary ECMO use. Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who were hospitalized between January to November between 2016-2018 for cardiogenic shock (ICD code R57.0) requiring ECMO support (ICD-10-PCS 5A15223). Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. A total of 10,723 patients underwent ECMO for cardiogenic shock from 2016 to 2018. After excluding patients who died (n=5,602; 52%) and those who underwent LVAD or OHT during index admission (n=892; 8%), 4,229 patients discharged alive were included in our analysis. Of those, 694 (16.4%) were re-admitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR=1.77; 95% CI 1.32-2.37), chronic liver disease (OR=1.35; 95% CI 1.03-1.77), and prolonged LOS (≥30 days; OR =1.38; 95% CI 1.05-1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50-0.95) and short-term hospital post discharge care (OR = 0.53; 95% CI 0.28-0.99) conferred a lower risk. Sepsis, followed by congestive heart failure were the more common causes for readmission. Proper identification of patients at increased risk for readmission may help improve prevention strategies and improve outcomes of cardiogenic shock after ECMO.