1. Predictors and Sources of Variation in 30-day Unplanned Readmission Following Isolated Coronary Artery Bypass Graft (CABG) Surgery in Australia
- Author
-
Shawon, MSR, Falster, M, Lujic, S, Hanly, M, Garland, S, Jorm, L, Shawon, MSR, Falster, M, Lujic, S, Hanly, M, Garland, S, and Jorm, L
- Abstract
BackgroundBetween-hospital variation in rates of 30-day unplanned readmission after coronary artery bypass graft (CABG) surgery has significant clinical and policy implications, but little is known about the relative contributions of patient- and hospital-level factors to this variation and how these may differ by the cause of readmission.MethodsWe identified a patient cohort who underwent isolated CABG between 2002 and 2018 and survived for at least 30 days post-discharge using linked hospital morbidity and death records for New South Wales residents. Predictors of 30-day unplanned readmission (all cause; stratified by major cardiovascular disease [CVD] or other primary diagnosis) were assessed using multilevel logistic regression models. Proportional changes in variance were used to estimate how much between-hospital variation was explained by patient- and hospital-level factors.ResultsOf 51,868 CABG patients (mean age 66 years, 20% female), 14.3% had unplanned readmission within 30 days. Female sex, older age, obesity, emergency procedure, longer hospital stay, and various comorbidities were associated with all-cause readmission. Three-quarters of readmissions had primary diagnoses other than major CVD (including respiratory causes, non-specific cardiac symptoms, and infections) and they contributed to greater between-hospital variation. Observed patient-level factors explained 74% of between-hospital variation for readmissions with major CVD, while for other readmissions, they explained only 31% and further 42% was explained by hospital-level factors (public vs. private status and CABG volume).ConclusionsReadmissions with non-CVD diagnoses drive much of the between-hospital variation in readmission rates, suggesting there is scope for hospital-level intervention to reduce unplanned readmission after CABG.
- Published
- 2021