Britt Borregaard1,2, Jan Sørensen3,4, Ola Ekholm5, Jacob E. Møller2,6, Lars P. Riber1,2, Lars Thrysoee2,6, Charlotte B. Thorup7, Marianne Vamosi8,9, Anne V. Christensen10, Trine B. Rasmussen11, Selina K. Berg5,101Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
2University of Southern Denmark, Odense, Denmark
3Danish Centre for Health Economics Research (COHERE), Institute of Public Health, University of Southern Denmark, Odense, Denmark
4Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
5National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
6Department of Cardiology, Odense University Hospital, Odense, Denmark
7Department of Cardiology and Department of Cardiothoracic Surgery & Clinical Nursing Research Unit. Aalborg University Hospital, Denmark
8Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
9Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
10The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
11Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte, Denmark
12Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: Readmissions after heart valve surgery represent a significant burden for both the patient and the healthcare system. The study aim was to identify independent predictors of readmission within 180 days after surgery in a population of patients undergoing heart valve surgery.
Methods: Demographic and clinical information was obtained from national registers. Patient-reported outcomes (PROs) including Short Form 12 (SF-12) and EuroQol 5D (EQ-5D) were measured at discharge as part of a national, cross-sectional study (DenHeart). Predictors of first readmission were investigated.
Results: Among a total of 1,084 patients (65% men; mean age 68 years; 354 responded to questionnaires), 534 (49%) were readmitted. Responding patients who were readmitted were younger and a greater proportion had undergone mitral valve surgery. A significantly higher proportion of
non-responders was readmitted. No significant differences were found in PROs between patients readmitted and those not readmitted, and receiver operating characteristic (ROC) curves showed no predictive effect of SF-12 and EQ-5D. Survival analysis using Cox proportional hazard models showed that prior percutaneous coronary intervention (PCI) (HR 1.50, CI 1.10; 2.05, p = 0.010) and a history of heart failure (HR 1.37, CI 1.10; 1.72, p = 0.006) were predictive of readmission.
Conclusion: Readmission rates after heart valve surgery are high and often seen in patients who have undergone PCI and heart failure before surgery. Predictors for these high readmissions rates are difficult to establish based on medical history and type of surgery. PROs at discharge contribute information regarding a patient’s perception of their often poor quality of life, but do not predict readmission.
The Journal of Heart Valve Disease 2018;27:78-86
|Sociodemographic, Clinical and Patient-Reported Outcomes and Readmission After Heart Valve Surgery|
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