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Ann Thorac Surg 2004;78:1972-1978
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Risk Factors for Readmission After Neonatal Cardiac Surgery

Andrew S. Mackie, MDa,c,*, Kimberlee Gauvreau, ScDa,c, Jane W. Newburger, MDa,c, John E. Mayer, MDb,d, Lars C. Erickson, MDa,c

a Department of Cardiology, Harvard Medical School, Boston, Massachusetts, USA
b Department of Cardiac Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
c Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
d Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

Accepted for publication May 18, 2004.

* Address reprint requests to Dr Mackie, Division of Cardiology, Montreal Children's Hospital, Room D-371, 2300 Tupper St, Montréal QC H3H 1P3, Canada
andrew.mackie{at}muhc.mcgill.ca

BACKGROUND: Repeat hospitalizations place a significant burden on health care resources. Factors predisposing infants to unplanned hospital readmission after congenital heart surgery are unknown.

METHODS: This is a single-center, case-control study. Cases were rehospitalized or died within 30 days of discharge following an arterial switch operation (ASO) or Norwood procedure (NP) between 1992 and 2002. Controls underwent an ASO or NP between 1992 and 2002, and were neither readmitted nor died within 30 days of discharge. Patients and controls were matched by gender, year of birth, and procedure. Potential risk factors examined included indices of medical status at the time of discharge, determinants of access to health care, and provider characteristics.

RESULTS: Forty-eight patients were readmitted; 19 of 498 (3.8%) following an ASO and 29 of 254 (11.4%) after a NP (p < 0.001). Six infants died within 30 days of discharge; 1 after an ASO and 5 after a NP. In multivariate analysis, predictors of readmission or death were: residual hemodynamic problem(s) (odds ratio [OR] 4.10 [1.18, 14.3], p = 0.026); an intensive care unit stay greater than 7 days (OR 5.17 [1.12, 23.9] p = 0.035) (ASO); residual hemodynamic problem(s) (OR 5.84 [1.98, 17.2], p = 0.001); and establishment of full oral intake less than 2 days before discharge (OR 5.83 [1.83, 18.6], p = 0.003) (NP). Combining both groups, living in a low income Zip Code (< $30,000/annum) was associated with a lower likelihood of readmission (OR 0.25 [0.07, 0.85], p = 0.027).

CONCLUSIONS: Residual hemodynamic problem(s) predispose to hospital readmission after the ASO and NP. Low socioeconomic status may reduce the likelihood of readmission even when problems arise.


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INVITED COMMENTARY
Wan Li
Ann. Thorac. Surg. 2004 78: 1978. [Extract] [Full Text] [PDF]





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