Original article
Adult cardiac
Causes, Risk Factors, and Costs of 30-Day Readmissions After Mitral Valve Repair and Replacement

Presented at the Poster Session of the Fifty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 26-29, 2019.
https://doi.org/10.1016/j.athoracsur.2019.07.033Get rights and content

Background

Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the risk factors and costs associated with readmissions after mitral valve (MV) surgery in a large, nationally representative cohort.

Methods

Adult patients undergoing MV repair or replacement were queried from the National Readmissions Database from 2010 to 2014. Data were collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure, and patient-level risk factors as determined by multivariable logistic regression.

Results

Among 76,342 patients undergoing MV surgery, the rate of 30-day readmission was 17.0%. Those undergoing replacement procedures had significantly higher readmission rates (20.7% vs 13.1%; P < .001) compared with repair. Significant independent predictors of readmission after both MV repair and replacement included length of stay ≥8 days, chronic lung disease, chronic renal disease, and low hospital procedural volume for MV surgery. Readmissions to nonindex hospitals accounted for 26.6% of all readmissions. The most common indications for readmission were heart failure (21.4%), arrhythmia (17.0%) and respiratory diagnoses (15.0%), and infections (10.2%). The mean cost per readmission was $15,397, and among readmitted patients, the cost of readmission accounted for 17.8% of the total cost of the episode of care.

Conclusions

Nearly 1 in 5 patients undergoing MV surgery are readmitted within 30 days. Treatment at a low-volume center was strongly associated with readmission, and much of the readmission burden falls on nonindex hospitals. Further characterization of readmissions may improve the quality of care associated with MV surgery.

Section snippets

Data Source

We performed a retrospective cohort study using the Nationwide Readmissions Database (NRD) with data from 2010 to 2014. The NRD is an all-payer database of hospital inpatient stays sponsored by the Agency for Healthcare Research and Quality as part of the Healthcare Cost and Utilization Project (HCUP).11 NRD data are collected from State Inpatient Databases, which included 16 states during the full study period. Sample weights offered in the database allow for estimates representative of 100%

Study Population

Patient demographics, comorbidities, hospital characteristics, and postoperative complications are listed in Table 1. A total of 76,342 eligible patients were identified as undergoing isolated MV surgery during the study period. More patients underwent MV replacement (52.3%) as opposed to MV repair (47.7%). The median hospital LOS was 8 (interquartile range [IQR], 5-13) days for the index admission, and 2.9% of patients died during index admission (these patients were excluded from the study

Rate of Readmission

In this study of the Nationwide Readmission Database, we identified an overall rate of 30-day readmission after MV surgery of 17.0%. Two prior studies could be identified that estimated the 30-day readmission rate after MV surgery. Dodson and colleagues identified a 30-day readmission rate of 21.0% studying Medicare claims data from 1999 to 2008.8 Vassileva and colleagues9 reported a readmission rate of 24.9% among 21,000 Medicare beneficiaries from 2000 to 2004. That both these studies of the

References (25)

  • S.L. Mick et al.

    Mitral valve repair vs replacement

    Ann Cardiothorac Surg

    (2015)
  • J.S. Gammie et al.

    Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database

    Ann Thorac Surg

    (2009)

    • Cited by (0)

    View full text
    © 2019 by The Society of Thoracic Surgeons Published by Elsevier