Readmission Rates For Patients Research Articles

Short-Term Outcomes of Total Arterial Revascularization Compared to Conventional Coronary Artery Bypass Graft in Patients with Multivessel Disease and Left Ventricular Dysfunction

Background. Multivessel coronary artery disease (CAD) and left ventricular dysfunction (LVD) present challenges in CABG. We aimed to compare early outcomes of total arterial revascularization (TAR) versus conventional CABG in this high-risk population. Methods. This was a retrospective cohort study based on a single-center registry of patients who underwent isolated CABG for multivessel CAD and LVD between January 2014 and December 2022. Primary outcome was in-hospital mortality. Secondary outcomes were early complications, graft patency rate at 3 months, readmission rate within 6 months, and freedom from angina rate within 6 months. Results. A total of 112 cases were included in this study; 52 patients for TAR and 60 patients for conventional CABG. Both groups had comparable baselines and operative profiles. In-hospital mortality was similar between TAR and conventional CABG (2 deaths, 3.85% vs 4 deaths, 6.67%, p = 0.810). TAR had shorter ICU (3.5 vs 5 days, p = 0.016) and hospital stay (10.5 vs 12 days, p = 0.007). Other postoperative complications were similar. At 3 months, TAR had superior graft patency (91.7% vs 83.7%, p = 0.034) and lower 6-month readmission (TAR: 2/50, 4.0% vs. CR: 10/56, 17.9%, p = 0.024). Freedom from angina rate within 6 months was similar between the two groups (TAR: 43/50, 86.0% vs. CR: 42/56, 75.0%, p = 0.240). Conclusion. Our findings suggest that TAR may offer benefits in terms of shorter hospital stays, higher early graft patency, and lower readmission rates for patients with multivessel CAD and LVD. However, further research, particularly large-scale, randomized trials with longer follow-up periods, are needed to fully understand the long-term clinical outcomes and confirm these promising early results.

The classification of obesity based on metabolic status redefines the readmission of non-Hodgkin’s lymphoma—an observational study

BackgroundThe relationship between obesity and non-Hodgkin’s lymphoma (NHL) was controversial, which may be due to the crudeness definition of obesity based on body mass index (BMI). As obesity and metabolic abnormalities often coexist, we aimed to explore whether the classification of obesity based on metabolic status can help to evaluate the real impact of obesity on the readmission of NHL.MethodsIn this retrospective cohort study, utilizing the 2018 Nationwide Readmissions Database, we identified NHL-related index hospitalizations and followed them for non-elective readmission. The patients with NHL were classified as metabolically healthy non-obese (MHNO) and obese (MHO) and metabolically unhealthy non-obese (MUNO) and obese (MUO). Readmission rates for each phenotype were calculated at 30-day intervals. Multiple COX regression was used to analyze the association of metabolic-defined obesity with 30-day, 90-day, and 180-day readmission rates in patients with NHL.ResultsThere were 22,086 index hospitalizations with NHL included. In the multivariate COX regression, MUNO was associated with increased 30-day (HR = 1.113, 95% CI 1.036–1.195), 90-day (HR = 1.148, 95% CI 1.087–1.213), and 180-day readmission rates (HR = 1.132, 95% CI 1.077–1.189), and MUO was associated with increased 30-day (HR=1.219, 95% CI: 1.081-1.374), 90-day (HR = 1.228, 95% CI 1.118–1.348), and 180-day readmission rates (HR = 1.223, 95% CI 1.124–1.33), while MHO had no associations with readmission rates.ConclusionsThe presence of metabolic abnormalities with or without obesity increased the risk of non-selective readmission in patients with NHL. However, obesity alone had no associations with the risk of non-selective readmission, suggesting that interventions for metabolic abnormalities may be more important in reducing readmissions of NHL patients.

Utility of Routine Blood Cultures for Upper Extremity Abscesses.

Patients with skin and soft tissue infections (SSTIs) are often admitted by the emergency department for intravenous antibiotic therapy and surgical drainage of abscesses if necessary. As part of the initial diagnostic workup, blood cultures are routinely drawn at our institution in patients with SSTIs. This study seeks to identify the utility of performing blood cultures in patients with upper extremity abscesses as it relates to the number of incision and drainage (I&D) procedures performed, patient readmission rates, and length of hospital stay. A retrospective chart review of 314 patients aged 18 to 89 years who underwent 1 or more I&D procedures of upper extremity abscesses were included in the study. Patient demographic data, comorbidities, laboratory values, wound and blood culture results, number of I&D procedures performed, length of stay, and readmission rates were evaluated. Increasing age and white blood count were associated with an increased number of I&Ds performed. Obtaining blood cultures, whether positive or negative, was associated with increased length of stay. There was no association between obtaining blood cultures and number of procedures performed on multivariable analysis. Positive blood cultures were associated with increased readmission rates. Routinely obtaining blood cultures in patients with upper extremity abscesses may not be beneficial. Obtaining blood cultures is not associated with an increased number of I&D procedures or readmission rates. Furthermore, obtaining blood cultures, regardless of positivity, is associated with increased lengths of hospital stay.

Building Prediction Models for 30-Day Readmissions Among ICU Patients Using Both Structured and Unstructured Data in Electronic Health Records.

ICU readmissions are associated with poor outcomes for patients and poor performance of hospitals. Patients who are readmitted have an increased risk of in-hospital deaths; hospitals with a higher read-mission rate have a reduced profitability, due to an increase in cost and reduced payments from Medicare and Medicaid programs. Predicting a patient's likelihood of being readmitted to the ICU can help reduce early discharges, the risk of in-hospital deaths, and help in-crease profitability. In this study, we built and evaluated multiple machine learning models to predict 30-day readmission rates of ICU patients in the MIMIC-III database. We used both the structured data including demographics, laboratory tests, comorbidities, and unstructured discharge summaries as the predictors and evaluated different combinations of features. The best performing model in this study Logistic Regression achieved an AUROC of 75.7%. This study shows the potential of leveraging machine learning and deep learning for predicting ICU readmissions.

The Efficacy of Self-care Behaviors, Educational Interventions, and Follow-up Strategies on Hospital Readmission and Mortality Rates in Patients with Heart Failure.

Heart failure (HF), a worldwide epidemic with significant morbidity and mortality risks, is frequently secondary to cardiovascular disorders and probably is the common final way to survive patients. Almost 25% of hospitalized patients with acute HF are expected to be readmitted within 30 days post-discharge, and the rates of rehospitalization increase to almost one-third at 60 days and 60 percent within one year of discharge. Although care planning for patients with heart failure is complex, multidisciplinary, and resource-dependent, optimal self-care management along with appropriate educational intervention and follow-up strategy could be able to reduce readmissions, decline the duration of hospitalization, increase life expectancy, decrease the rates of mortality, and reduce costs of healthcare services for patients with HF. However, there are contradictions in previous reports about the efficacy of self-care, mainly due to patients' non-adherence to self-care behaviors. Therefore, the current study aimed to review the investigations on the effectiveness of self-care of HF patients in reducing hospital readmissions and increasing quality of life, and discuss novel approaches for predischarge educational interventions and postdischarge follow-up strategies.

Impact of Clinical Pharmacists-driven Bundled Activities from Admission to Discharge on 90-day Hospital Readmissions and Emergency Department Visits.

Patient-centered clinical pharmacists' activities play a major role in improving clinical outcomes by optimizing the efficacy of drug therapies and minimizing associated toxicities during hospitalization, at the transition of care, and upon discharge. We aimed to compare the impact of comprehensive versus partial clinical pharmacists-driven bundled of care services on the rate of 90-day hospital readmissions and emergency department (ED) visits. This retrospective study included all admitted patients who received a comprehensive or partial bundle of clinical pharmacy services (medication history, interventions, counseling, and discharge prescription review) from 1 January 2021 to 30 June 2021 at Sultan Qaboos University Hospital. The comprehensive bundle of care included the four services, while the partial bundle of care included one, two, or three services only. Analyses were performed using univariate and multivariate statistical techniques. The study included 430 patients with a mean age of 56.021.0 years, and 43.7% (n = 188) were male. Of the patients, 12.1% (n = 52) received a comprehensive bundle of care. Compared with the partial bundle of care group, the comprehensive bundle of care group had significantly more patients with diabetes (65.4% vs. 42.9%; p =0.002), % 3 comorbidities (50.0% vs. 29.4%; p =0.003), and polypharmacy (% 5 medications) (73.1% vs. 46.0%; p < 0.001). The comprehensive bundle of care group was significantly associated with a lower 90-day readmission rate (adjusted odds ratio (aOR) = 0.27, 95% CI: 0.90?"0.82; p =0.021) but not with ED visits (aOR = 0.57, 95% CI: 0.13?"2.57; p =0.461). This study demonstrated a significant reduction in the 90-day readmission rate for patients on a comprehensive bundle of care but not ED visits. These findings emphasize the importance of the comprehensive services provided by clinical pharmacists on the healthcare resources use and clinical outcomes.

Risks for Readmission Among Older Patients With Chronic Obstructive Pulmonary Disease: An Analysis Using Korean National Health Insurance Service - Senior Cohort Data.

The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services. To apply transitional care services that are compatible with Korea's circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service's Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days. The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41). Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.

Heart failure drug classes and 30-day unplanned hospital readmission among patients with heart failure in Ethiopia

BackgroundDrug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure.MethodA multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI).ResultsIn this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission.ConclusionElderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.

Effect of Transitional Care Program on the Readmission Rate of Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

Effect of Transitional Care Program on the Readmission Rate of Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

Safety and outcomes of hip and knee replacement surgery in liver transplant recipients

BACKGROUND Liver transplant (LT) is becoming increasingly common with improved life expectancy. Joint replacement is usually a safe procedure; however, its safety in LT recipients remains understudied. AIM To evaluate the mortality, outcome, and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery. METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database. RESULTS A total of 5046119 hip and knee replacement surgeries were identified. 3219 patients had prior LT. Mean age of patients with no history of LT was 67.51 [95% confidence interval (CI): 67.44-67.58], while it was 64.05 (95%CI: 63.55-64.54) in patients with LT. Patients with history of LT were more likely to have prolonged length of hospital stay (17.1% vs 8.4%, P &lt; 0.001). The mortality rate for patients with no history of LT was 0.22%, while it was 0.24% for patients with LT (P = 0.792). Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization: 11.4% as compared to 6.2% in patients without history of LT (P &lt; 0.001). The mortality rate between both groups during readmission was not statistically different (1.9% vs 2%, P = 0.871) respectively. CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality; increased re-admissions were more frequent in this cohort of patients. Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.

Preclinical safety evaluation of continuous UV-A lighting in an operative setting.

Germicidal ultraviolet (UV-C) light has been shown as an effective modality for disinfection in laboratory settings and in the operative room. Traditionally, short-wavelength UV-C devices, which have previously been shown to cause DNA damage, are utilized only for disinfection in pre- and post-operative settings and are not continuously active during operations. Continuous use of intraoperative UV light has potential to decrease pathogens and subsequent surgical site infections (SSIs), which arise in approximately 5-15% of operative cases. SSIs are a significant determinant of patient morbidity, readmission rates, and overall cost. Therefore, a method of UV light disinfection with a low risk of DNA damage is needed so that greater antimicrobial protection can be afforded to patients during the entirety of their surgical procedures. A new disinfection device that harnesses longer-wavelength UV-A light to disinfect the surgical field throughout the entirety of the procedure, including pre- and post-operation has been developed. This study aimed to determine if UV-A light administered intraoperatively was safe, as defined by the minimal presence of DNA damage and safe amounts of reflection upon medical personnel. Using in vitro models, we examined the differential impacts of UV-C and UV-A light on DNA damage and repair pathways. In a murine model, we looked at the production of DNA damage photoproduction in relation to UV-A versus UV-C exposure. Our results show UV-A light does not induce a significant amount of DNA damage at the cellular or tissue level. Furthermore, a preclinical porcine study showed that surgical personnel were exposed to safe levels of UV-A irradiance from an overhead UV-A light used during an operation. The amount of UV-A transmitted through surgical personal protective equipment (PPE) also remained within safe levels. In conclusion, we found that UV-A may be safe for intraoperative use.

Do Weekend Discharges Impact Readmission Rate in Patients Undergoing Pancreatic Surgery?

BackgroundWeekend readmissions have been previously associated with increased mortality after pancreatic resection, but the effect of weekend discharge is less understood. In this study, we aim to determine the impact of weekend discharges on 30-day readmission rate after pancreatic surgery. MethodsAll patients who underwent pancreatic surgery at a single, high-volume institution between 2013 and 2021 were retrospectively reviewed from a targeted, institutional ACS-NSQIP database. Patients who died prior to discharge were excluded. Multivariable logistic regression was used to assess the relationship between readmission and weekend discharge. ResultsOut of 2042 patients who underwent pancreatectomy, 418 patients (20.5%) were discharged on the weekend. Weekend discharge was associated with fewer Whipple surgeries, fewer open surgical approaches, and shorter operative time. Patients discharged on the weekend were also less likely to have had postoperative complications such as delayed gastric emptying (DGE) (6.7% vs 12.6%, p < 0.01) and were more frequently discharged to home (91.1% vs. 85.3%, p < 0.01). Thirty-day readmission rate was almost identical between groups (14.8% vs 14.8%, p = 0.997). On multivariable analysis, 30-day readmission was independently associated with DGE (OR (95% CI): 3.48 (2.31–5.23), p < 0.01), postoperative pancreatic fistula (3.36 (2.34–4.83), p < 0.01), myocardial infarction, and perioperative blood transfusion, but not weekend discharge (1.02 (0.72–1.43), p = 0.93). Readmission rate also did not differ significantly when including Friday discharges in the weekend group (15.2% vs 14.6%, p = 0.72). ConclusionsWith careful clinical decision making, patients may safely be discharged on the weekend after pancreatic surgery without increasing 30-day readmission rate.

Readmission rates in HIV-associated burkitt lymphoma patients in the USA: a nationwide readmission database (NRD) analysis

BackgroundPeople with human immunodeficiency virus have an increased risk of developing AIDS-defining malignancies including Burkitt lymphoma. Survival outcomes in HIV-associated Burkitt lymphoma remain worse than non-HIV-associated Burkitt lymphoma, despite widespread implementation of antiretroviral therapy. We aimed to determine the association between HIV status and risk for 30-day and 90-day readmission in the US after index hospitalization for Burkitt lymphoma.MethodsData were abstracted from the 2010–2020 Nationwide Readmissions Database; hospitalizations included patients with a primary BL diagnosis and were stratified by comorbid HIV. The primary outcome was all-cause readmission (30-day and 90-day). Secondary outcomes were in-hospital mortality, length of stay (LOS), and hospital cost. Between-HIV differences were evaluated via logistic and log-normal regression; multivariable models adjusted for comorbid kidney disease, hypertension, fluid and electrolyte disorders, and sepsis.ResultsOverall, there were 8,453 hospitalizations for BL and 6.0% carried an HIV diagnosis. Of BL hospitalizations, 68.4% were readmitted within 30-days post index BL hospitalization and 6.8% carried a HIV diagnosis. HIV-associated BL was associated with 43% higher adjusted odds of 30-day readmission (aOR 95% CI: 4% higher to 97% higher, p = 0.026). For 90-day readmission, 76.0% of BL patients were readmitted and 7.0% carried a HIV diagnosis. HIV-associated BL was not statistically associated with all-cause 90-day readmission (aOR 1.46, aOR 95% CI: 0% higher to 115% higher, p = 0.053).ConclusionsHIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for Burkitt lymphoma.

Management strategies for acute cholecystitis in late pregnancy: a multicenter retrospective study

ObjectiveThis study aims to investigate the management strategies for acute cholecystitis in the third trimester of pregnancy by comparing the effectiveness of three different treatments.MethodsClinical data of 102 patients with acute cholecystitis in third trimester of pregnancy admitted to three Tertiary Hospitals from January 2010 to June 2020 were collected and divided into 3 groups according to the primary treatment during their first hospitalization: Group A (surgical group; n = 11), Group B (percutaneous transhepatic gallbladder drainage (PTGD) group, n = 29) and Group C (conservative treatment group, n = 62). The length of stay, readmission rate, and preterm delivery rate of each group were analyzed retrospectively.ResultsThe average age of patients included in this study was 29 ± 2.16 years with an average gestational cycle of 35.26 ± 1.02 weeks. The readmission rates of patients in groups A, B, and C were 9.09%, 24.14%, and 58.06%; the preterm delivery rates were 9.09%, 3.45%, and 12.90%; and the length of stay was 4.02 ± 1.02 days, 12.53 ± 2.21 days, and 11.22 ± 2.09 days, respectively. The readmission rate was lower in group A than in groups B and C, the preterm delivery rate was lower in group B than in groups A and C, and the length of stay was shorter in group A than in groups B and C (all with statistically significant differences, P < 0.05).ConclusionPatients with acute cholecystitis in late pregnancy need to be appropriately graded for severity and offered a sound treatment strategy after a thorough assessment of the condition while taking into account the willingness of the patients. For patients with mild severity, conservative treatment can be adopted; for patients with moderate or severe inflammation, PTGD can be performed first for symptom control, and wait till after delivery for surgery to be considered; and in some cases of critical condition and poor symptom control, surgical intervention should be promptly performed.

Participation in outpatient rehabilitation is associated with reduced readmission rates in patients with acute aortic dissection

Abstract Background Patients with acute aortic dissection (AAD) usually require a restriction of physical activity during hospitalisation, which frequently causes difficulty returning to their daily life. Additionally, the increase in the number of older patients with AAD, especially those with frailty, is a crucial problem to worsen clinical outcomes after medical and surgical treatment. Conversely, outpatient cardiovascular rehabilitation is recognized to improve physical function and reduce readmission rates in patients with heart diseases. Although several studies have documented the safety of physical activity intervention after AAD, the relationship between outpatient cardiovascular rehabilitation and clinical outcomes has not been thoroughly evaluated. Purpose This study aimed to examine whether outpatient cardiovascular rehabilitation is associated with clinical outcomes, including readmission rates and mortality, in patients with AAD. Methods This was a single-centre cohort study. We included the patients admitted to a tertiary hospital for treatment of AAD and who received cardiovascular rehabilitation during hospitalisation. Patient characteristics during hospitalisation included age, sex, body mass index, type of AAD as the Stanford classification, treatment information, and comorbidities. We also reviewed whether or not the patients participated in outpatient cardiovascular rehabilitation after discharge. The primary and secondary endpoints were readmission due to cardiovascular disease and all-cause death, respectively. We compared the differences in patient characteristics between the participation in outpatient rehabilitation. The Kaplan–Meier method with log-rank test and multivariate Cox regression analysis were used to examine the association of outpatient rehabilitation participation with the incidences of readmission and death. Results Among the 323 studied patients, 163 participated in outpatient rehabilitation, and 160 did not in. Participants in outpatient rehabilitation showed rates of higher surgical treatment and lower diabetes mellitus as compared with non-participants. There was a significant association between participation in outpatient rehabilitation and lower readmission rates (log-rank: P = 0.045, Figure 1). However, this association was not observed in all-cause death (log-rank: P = 0.063). After adjusting for patient characteristics as confounders, outpatient rehabilitation was significantly associated with lower readmission rates (adjusted hazard ratio [aHR]: 0.63, 95% confidence interval [CI]: 0.41–0.97) and with a tendency of low all-cause death without statistical significance (aHR: 0.51, 95% CI: 0.23–1.10). Conclusions In patients with AAD, participation in outpatient cardiovascular rehabilitation may be beneficial to reduce readmission rates after hospital discharge. Our findings suggest outpatient cardiovascular rehabilitation is one of the treatment options to improve clinical outcomes in these patients.

Worsening renal function in patients admitted with congestive heart failure: prevalence, risk profile, and hospital readmissions

Abstract Introduction Renal function is often negatively impacted in patients with Congestive Heart Failure (CHF) due to the interplay between the heart and kidneys. Worsening Renal Function (WRF) has been associated with decreased survival, accelerated CHF progression, and higher hospitalization rate. Previous literature has thoroughly documented the effects of CHF on hospital readmissions; however, few studies have examined the impact of WRF on CHF during hospitalization, particularly not in a vulnerable population. Thus, the aim of this study was to determine the prevalence, clinical predictors, and short-term hospital readmissions of WRF among hospitalized CHF patients. Methods This was a retrospective chart review utilizing the data of 297 patients hospitalized for CHF from 2019 to 2020, either due to an exacerbation of symptoms or new-onset of disease. The analysis of our study centered around identifying the risk factors and 30-day hospital readmission rates of patients with WRF, defined as an increase in serum creatinine of ≥ 0.3 mg/dL from admission, in comparison to patients who did not develop WRF. The significance between the two groups was measured using Fisher's Exact test, Wilcoxon rank-sum, and chi-square analysis. A risk score calculated from the sum of point values assigned to each independent risk factor was created. Results Data shows that 27% of hospitalized CHF patients developed WRF. Patients with WRF had a significantly longer hospital stay and a significantly higher increase in daily Creatinine values. We identified old age, overweight, type 2 diabetes (T2D), chronic kidney disease not on dialysis, and high Furosemide dose (oral and intravenous) as independent risk factors. Other independent risk factors include abnormally high serum levels of ProBNP (≥ 9,000 ng/dL), troponin T ≥ (0.04 ng/mm), and Creatinine (≥ 1.5 mg/dL). Based on this data, a point score reflected that patients with a 6+ risk score were four times more likely to develop WRF than patients with a risk score of 0. There was no association between WRF and higher 30-day readmissions. Conclusions WRF is common in hospitalized CHF patients. Although WRF was not associated with an increased 30-day hospital readmission rate, it was associated with longer hospital length of stay and thus increased economic burden. These results highlight the benefits of implementing in-care changes to address the particular risk factors associated with WRF to prevent further progression of renal impairment in hospitalized HF patients. Future directions will incorporate other outcome variables that discern the long-term implications of WRF, including 5-year readmission rates, ESKD, and mortality.

30- and 60-Day Readmission Rates for Children With Heart Failure in the United States

BackgroundStudies on readmission for pediatric heart failure (HF) patients is sparse. ObjectivesThis study evaluated 30- and 60-day readmission rates in pediatric HF patients from 2010 to 2019. MethodsThe authors used data from the Nationwide Readmission Database to evaluate trends in 30- and 60-day hospital readmissions among pediatric patients with HF and compare them with adults with HF. Readmissions were also stratified by sex, diagnosis, neighborhood income, and hospital volume. ResultsThere were 84,731 hospital admissions for HF. Compared with children without HF, those with HF were older, had Medicare/Medicaid insurance, and resided in micropolitan areas and low-income neighborhoods. The 30- (19.5% vs 3.1%) and 60-day (27.5% vs 4.3%) all-cause readmission rates were higher for children with HF compared with those without HF. Compared with children without HF, lengths of stay, deaths, and costs related to their readmission were higher for children readmitted with HF (P < 0.05 for all). There was no significant decline in pediatric HF-related 30- or 60- day readmissions during the study period overall, or for those with congenital heart disease (P > 0.05), unlike adult HF readmissions (P < 0.01). Infants were at highest risk, and readmission rates for teenagers are rising. ConclusionsThe 30- and 60-day readmission rates for pediatric patients with HF in the current era is high (∼20% and 30%, respectively). Unlike adult HF, pediatric HF readmission rates have not declined. Pediatric HF patients readmitted to the hospital have higher death rates and greater resource utilization than patients without HF. National measures to decrease readmissions for pediatric patients with HF is warranted.

Abstract 11637: Using Dielectric Sensing in Making Discharge Decision for Patients With Heart Failure

Introduction: Decompensated heart failure is a leading cause of hospitalization in the United States and is driven by high readmission rates. Despite numerous advancements in diagnosing and treating advanced heart failure, there remains a lack of validated measures to predict patient volume status and readmission rates. Remote dielectric sensing (ReDS) is a non-invasive, radiation-free measure of lung fluid content. Hypothesis: We aim to assess the utility of ReDS in guiding clinical management and as a quantitative metric to predict 30-day readmission rates. We predict normalization of lung fluid value before discharge will have a lower 30-day readmission rate than patients with no normal value before discharge. Methods: Lung fluid values were collected using ReDS vests for 1,224 patients with advanced heart failure. Our retrospective analysis compared patients with normalization of lung fluid values during admission to patients without normalization of these measures to determine a difference in readmission rates between groups. Secondary analyses were performed to assess the effects of other clinical markers, including ejection fraction and age, on lung fluid values and 30-day readmission rates for individual patients. Results: The primary comparison between patients with normal lung fluid values at discharge and patients without normalization of lung fluid values revealed a trend towards lower readmission for those with normalization of lung fluid values (16.6% vs. 29.2%, p=0.07). No differences were observed in patients who had non-normal repeat lung fluid values before discharge and those who did not receive a repeat measure (29.2% vs. 29.8%, p=0.88). Readmitted patients had a higher initial lung fluid value (45±6.6 versus 44 ± 5.9, p=0.02). No differences in lung fluid values at discharge or changes during hospitalization were observed. Conclusions: Remote dielectric sensing may predict lower readmission rates in patients whose values normalize during admission compared to patients with non-normalized values. Future prospective studies are necessary to determine the full utility of ReDS in the clinical setting.

Abstract 14962: Rate of 30-Day Readmission and Economic Burden of Sickle Cell Disease Patients Who Underwent Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Procedure for ST Elevation Myocardial Infarction

Introduction: Sickle cell disease (SCD) is an inherited disorder in which microvascular occlusion causes complications across multiple organ systems, including the heart. Heart problems are among the most common causes of death in people with SCD. Macrovascular complications can also transpire among SCD. Hypothesis: We sought to determine the 30-Day Readmission rate (30-DRr) of patients with SCD who underwent Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) procedure for ST-Elevation Myocardial Infarction (STEMI) and its impact on mortality and healthcare utilization in the United States. Methods: Using the 2020 National Readmission Database, we conducted a retrospective analysis of patients with SCD after PCI and CABG for STEMI as a principal diagnosis according to ICD-10 codes. Readmission was the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. The primary outcome was 30DRr, while secondary outcomes were readmission mortality rate and resource utilization defined by length of stay &amp; patient charge. Results: 77 index hospitalization was observed with a mean age of 57.4 SD± 4.2 years, and 70.6 % were females. The in-hospital mortality rate for index admission was 6.5% (5 of 77), while 30-DRr was 20.8% (15 of 72) (Figure 1). Among this group of readmitted patients (mean age was 61.2 SD± 10.5 years, &amp; 57% were males), In-hospital mortality rate was 13.3% (2 of 15). However, observed 30-DRr among Non-SCD was 9.02% (36,564 of 405,526), which is lower, as well as lower inpatient index and readmission mortality of 4.81% (19,507 of 405,426) and 4.83% (1,764 of 36,564) respectively. Conclusions: Approximately 1 in 5 patients who underwent PCI and CABG procedures for STEMI with underlying SCD had 30-DRr. Readmission mortality was higher compared to index mortality but was not statistically significant. SCD patients are a vulnerable subset who will benefit from outpatient multidisciplinary care.

Abstract 14971: Rate of 30-Day Readmission and Economic Burden of End-Stage Renal Disease Patients Who Underwent Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Procedure for ST - Elevation Myocardial Infarction

Introduction and Hypothesis: We sought to determine the 30-Day Readmission rate (30-DRr) of patients with End-Stage Renal Disease (ESRD) who underwent Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) Procedure for ST-Elevation Myocardial Infarction (STEMI) and its impact on mortality and healthcare utilization in the United States. Methods: Using the 2020 National Readmission Database, we conducted a retrospective analysis of patients with ESRD after PCI and CABG procedure for STEMI as a principal diagnosis according to ICD-10 codes. Readmission was the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. The primary outcome was 30DRr, while secondary outcomes were readmission mortality rate and resource utilization defined by length of stay and patient charge. Results: A total of 13,753 index hospitalization was observed with a mean age was 68.5 SD±12.9 years, and 60.4% of patients were males. The in-hospital mortality rate for index admission was 8.4% (1,153 of 13,753), while 30-DRr was 20.6% (2,596 of 12,600) (Figure 1). Among this group of readmitted patients (mean age was 66 SD±12.4 years, 59.6% of patients were males), the In-hospital mortality rate was 6.4% (166 of 2,596). However, observed 30-DRr among Non-ESRD patients was 9.02% (36,564 of 405,526), which is lower, as well as lower inpatient index and readmission mortality of 4.81% (19,507 of 405,426) and 4.83% (1,764 of 36,564) respectively. A healthcare economic burden of $214,000,000 among readmitted ESRD patients. Conclusions: Approximately 1 in 5 patients who underwent PCI and CABG procedure for STEMI with underlying ESRD had 30-DRr, with subsequent readmissions associated with healthcare spending. Readmission mortality was statistically lower than index mortality. ESRD patients are a vulnerable subset who will benefit from outpatient multidisciplinary care.