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Factors associated with 30-day readmission rates after percutaneous coronary intervention. 2012

Farhan J Khawaja, and Nilay D Shah, and Ryan J Lennon, and Joshua P Slusser, and Aziz A Alkatib, and Charanjit S Rihal, and Bernard J Gersh, and Victor M Montori, and David R Holmes, and Malcolm R Bell, and Jeptha P Curtis, and Harlan M Krumholz, and Henry H Ting
Mayo Clinic, Rochester, MN 55905, USA.

BACKGROUND Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI). However, little is known regarding the factors associated with 30-day readmission after PCI. METHODS To assess the demographic, clinical, and procedural factors associated with 30-day readmission rates after PCI, we identified 15, 498 PCI hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 at Saint Marys Hospital, Rochester, Minnesota. All were included in this analysis. Multivariate logistic regression models were used to estimate the adjusted association between demographic, clinical, and procedural variables and 30-day readmission. The association between 30-day readmission and 1-year mortality was estimated using Cox proportional hazards models with readmission as a time-dependent covariate and by using landmark analysis. The main outcome measures were all-cause 30-day readmission to any hospital following PCI and 1-year mortality. RESULTS Overall, 9.4% of PCIs (n = 1459) were readmitted, and 0.68% of PCIs (n = 106) resulted in death within 30 days after discharge. After multivariate analysis, female sex, Medicare insurance, having less than a high school education, unstable angina, cerebrovascular accident or transient ischemic attack, moderate to severe renal disease, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer, and a length of stay of more than 3 days were associated with an increased risk of 30-day readmission after PCI. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality (adjusted hazard ratio, 1.38; 95% CI, 1.08-1.75; P = .009). CONCLUSIONS Nearly 1 in 10 patients undergoing PCI were readmitted within 30 days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality.

UI MeSH Term Description Entries
D007674 Kidney Diseases Pathological processes of the KIDNEY or its component tissues. Disease, Kidney,Diseases, Kidney,Kidney Disease
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D008297 Male Males
D009203 Myocardial Infarction NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). Cardiovascular Stroke,Heart Attack,Myocardial Infarct,Cardiovascular Strokes,Heart Attacks,Infarct, Myocardial,Infarction, Myocardial,Infarctions, Myocardial,Infarcts, Myocardial,Myocardial Infarctions,Myocardial Infarcts,Stroke, Cardiovascular,Strokes, Cardiovascular
D009362 Neoplasm Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Metastase,Metastasis,Metastases, Neoplasm,Metastasis, Neoplasm,Neoplasm Metastases,Metastases
D010359 Patient Readmission Subsequent admissions of a patient to a hospital or other health care institution for treatment. Hospital Readmission,Rehospitalization,Unplanned Hospital Readmissions,Unplanned Readmission,30 Day Readmission,Hospital Readmissions,Readmission, Hospital,Readmissions, Hospital,Thirty Day Readmission,30 Day Readmissions,Hospital Readmission, Unplanned,Hospital Readmissions, Unplanned,Readmission, Patient,Readmission, Thirty Day,Readmission, Unplanned,Rehospitalizations,Thirty Day Readmissions,Unplanned Hospital Readmission,Unplanned Readmissions
D010437 Peptic Ulcer Ulcer that occurs in the regions of the GASTROINTESTINAL TRACT which come into contact with GASTRIC JUICE containing PEPSIN and GASTRIC ACID. It occurs when there are defects in the MUCOSA barrier. The common forms of peptic ulcers are associated with HELICOBACTER PYLORI and the consumption of nonsteroidal anti-inflammatory drugs (NSAIDS). Gastroduodenal Ulcer,Marginal Ulcer,Gastroduodenal Ulcers,Marginal Ulcers,Peptic Ulcers,Ulcer, Gastroduodenal,Ulcer, Marginal,Ulcer, Peptic,Ulcers, Gastroduodenal,Ulcers, Marginal,Ulcers, Peptic
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D002546 Ischemic Attack, Transient Brief reversible episodes of focal, nonconvulsive ischemic dysfunction of the brain having a duration of less than 24 hours, and usually less than one hour, caused by transient thrombotic or embolic blood vessel occlusion or stenosis. Events may be classified by arterial distribution, temporal pattern, or etiology (e.g., embolic vs. thrombotic). (From Adams et al., Principles of Neurology, 6th ed, pp814-6) Brain Stem Ischemia, Transient,Cerebral Ischemia, Transient,Crescendo Transient Ischemic Attacks,Transient Ischemic Attack,Anterior Circulation Transient Ischemic Attack,Brain Stem Transient Ischemic Attack,Brain TIA,Brainstem Ischemia, Transient,Brainstem Transient Ischemic Attack,Carotid Circulation Transient Ischemic Attack,Posterior Circulation Transient Ischemic Attack,TIA (Transient Ischemic Attack),Transient Ischemic Attack, Anterior Circulation,Transient Ischemic Attack, Brain Stem,Transient Ischemic Attack, Brainstem,Transient Ischemic Attack, Carotid Circulation,Transient Ischemic Attack, Posterior Circulation,Transient Ischemic Attack, Vertebrobasilar Circulation,Transient Ischemic Attacks, Crescendo,Vertebrobasilar Circulation Transient Ischemic Attack,Attack, Transient Ischemic,Attacks, Transient Ischemic,Brainstem Ischemias, Transient,Cerebral Ischemias, Transient,Ischemia, Transient Brainstem,Ischemia, Transient Cerebral,Ischemias, Transient Brainstem,Ischemias, Transient Cerebral,Ischemic Attacks, Transient,TIA, Brain,TIAs (Transient Ischemic Attack),Transient Brainstem Ischemia,Transient Cerebral Ischemia,Transient Cerebral Ischemias,Transient Ischemic Attacks
D004522 Educational Status Educational attainment or level of education of an individual. Education Level,Educational Achievement,Educational Attainment,Educational Level,Level of Education,Maternal Education Level,Maternal Educational Attainment,Maternal Educational Level,Paternal Education Level,Paternal Educational Attainment,Paternal Educational Level,Achievement, Educational,Educational Status, Maternal,Educational Status, Paternal,Maternal Educational Status,Paternal Educational Status,Status, Educational,Attainment, Educational,Attainment, Maternal Educational,Attainment, Paternal Educational,Education Level, Maternal,Education Level, Paternal,Education Levels,Educational Achievements,Educational Attainment, Maternal,Educational Attainment, Paternal,Educational Attainments,Educational Level, Maternal,Educational Level, Paternal,Educational Levels,Level, Education,Level, Educational,Level, Maternal Education,Level, Maternal Educational,Level, Paternal Education,Level, Paternal Educational,Levels, Maternal Educational,Maternal Education Levels,Maternal Educational Attainments,Maternal Educational Levels,Paternal Education Levels,Paternal Educational Attainments,Paternal Educational Levels,Status, Maternal Educational,Status, Paternal Educational

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