Discharge Day Not a Significant Factor for Readmission After Cardiac Surgery

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Weekend discharge did not increase rates of hospital readmission after cardiac surgery in this study cohort.
Weekend discharge did not increase rates of hospital readmission after cardiac surgery in this study cohort.

Patients discharged on a weekend day or holiday after undergoing major cardiac surgery were not at higher risk of 30-day all-cause readmission compared with patients discharged on a weekday, according to study results published in The Annals of Thoracic Surgery.

The investigators of this single-center retrospective study sought to assess potentially modifiable variables in the discharge process for major cardiac surgery; specifically, they wanted to learn whether the day of discharge affects readmission rates and if patients discharged for cardiac surgery were vulnerable to the weekend effect phenomenon.

The study cohort included 4877 adults registered in the Society of Thoracic Surgeons database who underwent elective cardiac operations between 2008 and 2016; patients were categorized by weekday discharge or weekend and holiday discharge. All-cause readmission rates within 30 days of surgery were the primary study outcome.

A multivariable logistic regression model was developed to predict risk of readmission, adjusting for variables including patient comorbidities, operative performance, and postoperative complications.

The study results showed that while 19.6% of the total cohort was discharged on a weekend or holiday, the overall 30-day readmission rate of 11.3% was similar between weekday vs weekend or holiday cohorts (11.4% vs 11.0%; P =.73). Higher readmission rates were associated with patients discharged to a secondary facility vs patients discharged to home (16.7% vs 12.7%; P <.001), and the proportion of patients discharged to facilities was greater on weekdays vs weekends and holidays (15.0% vs 5.7%; P <.001).

After adjusting for variables, weekend and holiday discharge days were not associated with increased readmission rates (adjusted odds ratio, 1.01; 95% CI, 0.77-1.32). 

Limitations to this retrospective study included potential bias between weekday and weekend discharge cohorts — largely because randomization of discharge day was impractical — and the inability to characterize cost and length of readmission stays. As the study was performed at a single institution, the generalizability of the study findings to other institutions is limited.

Patients that underwent major cardiac surgery and who were discharged over a weekend or holiday were not associated with increased risk of 30-day all-cause readmission regardless of patient factors and operative performance.

The investigators suggest that hospital resources for weekend staffing may be better allocated for infection site prevention and outpatient intervention programs.

Reference         

Sanaiha Y, Ou R, Ramos G, Jou YY, Shemin RJ, Benharash P. Day of discharge does not impact hospital readmission after major cardiac surgery [published October 11, 2018]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2018.07.031

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