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Predicted Risk of Mortality Score predicts 30-day readmission after coronary artery bypass grafting

  • Joshua M. RosenblumEmail author
  • Brendan P. Lovasik
  • John C. Hunting
  • Jose Binongo
  • Michael E. Halkos
  • Bradley G. Leshnower
  • Jeffrey S. Miller
  • Omar M. Lattouf
  • Robert A. Guyton
  • William B. Keeling
Original Article
  • 7 Downloads

Abstract

Objective

Quality metrics and reimbursement models focus on 30-day readmission rates after coronary artery bypass grafting (CABG). Certain preoperative variables are associated with higher rates of readmission. The purpose of this study was to determine whether STS Predicted Risk of Mortality (PROM) scores predict 30-day readmission following CABG.

Methods

A retrospective review of all patients undergoing isolated CABG between 2002 and 2017 at a US academic institution was performed. Logistic regression analysis was used to determine the association between PROM and 30-day readmission, and the area under the receiver-operator curve (ROC) was calculated to estimate predictive accuracy.

Results

During the study period, 21,719 patients underwent CABG and 2,023 (9.2%) were readmitted within 30 days. Readmitted patients were sicker with higher rates of comorbid conditions and higher STS PROM scores (1.03% vs 1.42%, GMR 1.33, CI 1.27–1.38, p < 0.0001). Median time to readmission was 8 days (IQR 4–15) with length of stay 5 days (4–6). By PROM quintile, higher PROM scores were associated with increased odds of readmission. PROM-adjusted 30-day mortality was higher in the readmitted group (1.04% vs 0.21%, OR 4.53, CI 2.67–7.69, p < 0.001), and mid-term survival was worse as well. PROM alone was a modest predictor of readmission (area under ROC 0.59, CI 0.57–0.60) compared to insurance status (0.55, 0.53–0.56), ejection fraction (0.52, 0.50–0.54), and history of heart failure (0.51, 0.50–0.52).

Conclusion

STS PROM scores are associated with increased risk of readmission following CABG.

Keywords

Readmission CABG STS PROM 

Abbreviations

AUC

Area under the curve

CABG

Coronary artery bypass graft

PROM

STS Predicted Risk of Mortality Score

ROC

Receiver–operator curve

STS

Society of Thoracic Surgeons

Notes

Funding

There was no funding source for this project.

Compliance with ethical standards

Conflict of interest

There are no relevant conflicts of interest to report for any of the authors.

Supplementary material

11748_2019_1079_MOESM1_ESM.tiff (1.5 mb)
Receiver-operator curve for predictive value of PROM on 30-day mortality (TIFF 1522 KB)
11748_2019_1079_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 12 KB)

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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Joshua M. Rosenblum
    • 1
    Email author
  • Brendan P. Lovasik
    • 2
  • John C. Hunting
    • 3
  • Jose Binongo
    • 3
  • Michael E. Halkos
    • 1
  • Bradley G. Leshnower
    • 1
  • Jeffrey S. Miller
    • 1
  • Omar M. Lattouf
    • 1
    • 2
  • Robert A. Guyton
    • 1
    • 2
  • William B. Keeling
    • 1
  1. 1.Division of Cardiac Surgery, Department of Surgery, The Emory ClinicEmory University School of MedicineAtlantaUSA
  2. 2.Department of SurgeryEmory University School of MedicineAtlantaUSA
  3. 3.Department of Biostatistics, Rollins School of Public HealthEmory UniversityAtlantaUSA

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