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Healthcare delivery, economics and global health
Original research
Evaluation of hospital readmission rates as a quality metric in adult cardiac surgery
  1. Shayan Ebrahimian1,
  2. Syed Shahyan Bakhtiyar1,2,3,
  3. Arjun Verma1,
  4. Catherine Williamson1,
  5. Sara Sakowitz1,
  6. Konmal Ali1,
  7. Nikhil L Chervu1,2,
  8. Yas Sanaiha1,2,
  9. Peyman Benharash1,2
  1. 1 Cardiovascular Outcomes Research Laboratories, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2 Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  3. 3 Department of Surgery, University of Colorado Aurora, Aurora, Colorado, USA
  1. Correspondence to Dr Peyman Benharash, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; pbenharash{at}mednet.ucla.edu

Abstract

Objective To assess the reliability of 30-day non-elective readmissions as a quality metric for adult cardiac surgery.

Background Unplanned readmissions is a quality metric for adult cardiac surgery. However, its reliability in benchmarking hospitals remains under-explored.

Methods Adults undergoing elective isolated coronary artery bypass grafting (CABG), surgical aortic valve replacement/repair (SAVR) or mitral valve replacement/repair (MVR) were tabulated from 2019 Nationwide Readmissions Database. Multi-level regressions were developed to model the likelihood of 30-day unplanned readmissions and major adverse events (MAE). Random intercepts were estimated, and associations between hospital-specific risk-adjusted rates of readmissions and were assessed using the Pearson correlation coefficient (r).

Results Of an estimated 86 024 patients meeting study criteria across 298 hospitals, 62.6% underwent CABG, 22.5% SAVR and 14.9% MVR. Unadjusted readmission rates following CABG, SAVR and MVR were 8.4%, 9.3% and 11.8%, respectively. Unadjusted MAE rates following CABG, SAVR and MVR were 35.1%, 32.3% and 37.0%, respectively. Following adjustment, interhospital differences accounted for 4.1% of explained variance in readmissions for CABG, 7.6% for SAVR and 10.0% for MVR. There was no association between readmission rates for CABG and SAVR (r=0.10, p=0.09) or SAVR and MVR (r=0.09, p=0.1). A weak association was noted between readmission rates for CABG and MVR (r=0.20, p<0.001). There was no significant association between readmission and MAE for CABG (r=0.06, p=0.2), SAVR (r=0.04, p=0.4) and MVR (r=−0.03, p=0.6).

Conclusion Our findings suggest that readmissions following adult cardiac surgery may not be an ideal quality measure as hospital factors do not appear to influence this outcome.

  • Cardiac surgery
  • Health Care Economics and Organizations
  • Outcome Assessment, Health Care

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are publicly available from Healthcare Cost and Utilization Project (HCUP) upon completion of Data Use Agreement for researchers who meet the criteria for access to confidential data. Data cannot be provided directly by the authors due to specific approval required by HCUP. The authors had no special access privileges to the data that others would not have. As such, requests for data acquisition should be forwarded to the HCUP.

https://doi.org/10.1136/heartjnl-2023-322671

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are publicly available from Healthcare Cost and Utilization Project (HCUP) upon completion of Data Use Agreement for researchers who meet the criteria for access to confidential data. Data cannot be provided directly by the authors due to specific approval required by HCUP. The authors had no special access privileges to the data that others would not have. As such, requests for data acquisition should be forwarded to the HCUP.

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    Footnotes

    • Twitter @Shayan_ebr, @Aortologist

    • Contributors SE, SSB and PB designed the study. SE, SB, AV, CW, SS and YS analysed and interpreted data. SE, SB, NLC, KA and PB wrote the manuscript and all authors revised it. PB serves as the overall guarantor responsible for overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PB received proctor fees from AtriCure as a surgical proctor. This manuscript does not discuss any AtriCure products or services. Other authors report no conflicts or disclosures. The authors have no funding sources to declare.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.