Relation of Length of Stay to Unplanned Readmissions For Patients Who Undergo Elective Percutaneous Coronary Intervention

Gunning, M; Nolan, J; Kontopantelis, E; Bertrand, O; Kwok, CS; Rao, S; Gilchrist, I; Potts, J; Nagaraja, V; Mamas, M

Abstract

The cost of inpatient PCI procedure is related to LOS. It is unknown how LOS may be associated with readmission rates and costs of index PCI and readmissions in elective PCI. This study aims to evaluate rates, predictors, causes and costs associated with 30-day unplanned readmissions according to length of stay (LOS) in patients who undergo elective percutaneous coronary interventions (PCI). We included patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014 who underwent uncomplicated elective PCI. LOS was defined as 0, 1, 2 and =3 days. A total of 324,345 patients were included in the analysis and the 30-day unplanned readmission was 4.75%, 4.67%, 6.44% and 9.42% in the LOS groups 0, 1, 2 and =3 days, respectively. Prolonged LOS was associated with increased average total 30-day cost (index and readmission cost, 0 days $15,063, 1 day $14,693, 2 days $18,136 and =3 days $24,336). Compared to 0 days, the odds of readmissions were greater for 2 days (OR 1.41 95%CI 1.07-1.87, p=0.016) and =3 days (OR 1.70 95%CI 1.28-2.24, p<0.001). Comorbidities were strong predictors of LOS and non-cardiac causes account for more than half of all causes for readmission. Longer LOS was associated with reduced incidence of readmissions for non-cardiac causes such as non-cardiac chest pain but a greater rate of readmissions for heart failure. In conclusion, shorter length of stay was associated with reduced healthcare costs in elective PCI.

Citation

Gunning, M., Nolan, J., Kontopantelis, E., Bertrand, O., Kwok, C., Rao, S., …Mamas, M. (2019). Relation of Length of Stay to Unplanned Readmissions For Patients Who Undergo Elective Percutaneous Coronary Intervention. The American Journal of Cardiology, 123(1), 33-43. https://doi.org/10.1016/j.amjcard.2018.09.028

• Journal Article Type: Article
• Acceptance Date: Sep 11, 2018
• Publication Date: Jan 1, 2019
• Journal: The American Journal of Cardiology
• Print ISSN: 0002-9149
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 123
• Issue: 1
• Pages: 33-43
• DOI: https://doi.org/10.1016/j.amjcard.2018.09.028
• Keywords: percutaneous coronary intervention, readmissions, length of stay
• Publisher URL: http://doi.org/10.1016/j.amjcard.2018.09.028