Predictors of Hospital Readmission for Patients Undergoing Cardiac Surgeries

Cardiovascular diseases (CVDs) are conditions of the heart and blood vessels that lead to significant morbidity and mortality, burden the global public health system, and are the main cause of death worldwide. CVD accounted for approximately 19.05 million global deaths in 2020. CVD is listed as the first underlying cause of death, with more than 800000 deaths in the United States in 2019. Between 2015 and 2018, 126.9 million US adults had some form of CVD. Between 2017 and 2018, direct and indirect costs of total CVD were $378.0 billion ($226.2. billion in direct costs and $151.8 billion in lost productivity/mortality).

Cardiac surgery continues to play an important role in the management of various cardiovascular disorders, including the treatment of seriously and critically ill patients. The most frequently performed procedures include coronary artery bypass graft (CABG) and valvular surgery. According to the Society of Thoracic Surgeons, the number of cardiac surgeries exceeds 300000 procedures in 2019 in the United States. Despite tremendous advancements in cardiac surgery over the past few years, postoperative hospital readmissions after cardiac surgeries still present significant challenges.

Readmission occurs when a patient is admitted to the same or a different hospital after being discharged from the relevant hospital and placed in a non-acute setting, such as his home, within a predetermined amount of time. Readmission within 30 days of adult cardiac surgery is a difficult and costly problem, with rates ranging from 8% to 21%. In addition to delayed return to activities of daily living and reduced quality of life, readmission is associated with a financial cost for patients and healthcare facilities. Increased facility costs can be substantial, especially when combined with reimbursement penalties, the cost of skilled care, and potential legal expenses.

Readmission after cardiac surgery is common and moderately predictable. According to a study done in a multi-institutional hospital in Ontario, Canada on patients who underwent CABG and/or valve surgery from 2008 to 2016, the 30-day readmission rate was 11.5% overall. Patients who were readmitted were older with higher incidences of cardiac comorbidities compared with non-readmitted patients. Significant risk factors for readmission from the final model were the prolonged length of stay, isolated valve surgery, in-hospital complications of sepsis, acute myocardial infarction, diabetes mellitus, gastrointestinal problems wound infection, postoperative acute renal failure, atrial fibrillation (AF), chronic lung disease, obesity, hematocrit <35% before surgery, cardiopulmonary bypass, especially bypass durations of more than 100 minutes.

Perioperative nurses may positively affect reducing readmission rates at different stages of the perioperative continuum of care. All nursing interventions play an important role in minimizing patient risk and preventing or reducing the number of readmissions. Nursing strategies to reduce postoperative cardiac surgery readmission include central line and urinary catheter insertion, cardiopulmonary bypass circuit maintenance, temperature regulation, hair removal, and skin preparation, glycemic control, care of the incision site, treatment and prevention of dysrhythmia, pleural effusion and retained blood syndrome, appropriate discharge teaching, following up with the patients after discharge through telephone conversations and post-discharge care.