Clinical trial NCT06038266: Predictors of Hospital Readmission for Patients Undergoing Cardiac Surgeries
Official title: Predictors of Hospital Readmission for Patients Undergoing Cardiac Surgeries
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Cardiac Surgery, Readmission
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2023-09-14
Enrollment: 121
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study will include a sample of 121 adult patients (male and female) who are undergoing CABG or Cardiac Valvular surgeries and whose age is from 18 to 65 years old.

Brief summary: This study aimed to identify the predictors of hospital readmission for patients undergoing cardiac surgeries.

Detailed description: Cardiovascular diseases (CVDs) are conditions of the heart and blood vessels that lead to significant morbidity and mortality, burden the global public health system, and are the main cause of death worldwide. CVD accounted for approximately 19.05 million global deaths in 2020. CVD is listed as the first underlying cause of death, with more than 800000 deaths in the United States in 2019. Between 2015 and 2018, 126.9 million US adults had some form of CVD. Between 2017 and 2018, direct and indirect costs of total CVD were $378.0 billion ($226.2. billion in direct costs and $151.8 billion in lost productivity/mortality).

Cardiac surgery continues to play an important role in the management of various cardiovascular disorders, including the treatment of seriously and critically ill patients. The most frequently performed procedures include coronary artery bypass graft (CABG) and valvular surgery. According to the Society of Thoracic Surgeons, the number of cardiac surgeries exceeds 300000 procedures in 2019 in the United States. Despite tremendous advancements in cardiac surgery over the past few years, postoperative hospital readmissions after cardiac surgeries still present significant challenges.

Readmission occurs when a patient is admitted to the same or a different hospital after being discharged from the relevant hospital and placed in a non-acute setting, such as his home, within a predetermined amount of time. Readmission within 30 days of adult cardiac surgery is a difﬁcult and costly problem, with rates ranging from 8% to 21%. In addition to delayed return to activities of daily living and reduced quality of life, readmission is associated with a ﬁnancial cost for patients and healthcare facilities. Increased facility costs can be substantial, especially when combined with reimbursement penalties, the cost of skilled care, and potential legal expenses.

Readmission after cardiac surgery is common and moderately predictable. According to a study done in a multi-institutional hospital in Ontario, Canada on patients who underwent CABG and/or valve surgery from 2008 to 2016, the 30-day readmission rate was 11.5% overall. Patients who were readmitted were older with higher incidences of cardiac comorbidities compared with non-readmitted patients. Signiﬁcant risk factors for readmission from the ﬁnal model were the prolonged length of stay, isolated valve surgery, in-hospital complications of sepsis, acute myocardial infarction, diabetes mellitus, gastrointestinal problems wound infection, postoperative acute renal failure, atrial ﬁbrillation (AF), chronic lung disease, obesity, hematocrit \<35% before surgery, cardiopulmonary bypass, especially bypass durations of more than 100 minutes.

Perioperative nurses may positively affect reducing readmission rates at different stages of the perioperative continuum of care. All nursing interventions play an important role in minimizing patient risk and preventing or reducing the number of readmissions. Nursing strategies to reduce postoperative cardiac surgery readmission include central line and urinary catheter insertion, cardiopulmonary bypass circuit maintenance, temperature regulation, hair removal, and skin preparation, glycemic control, care of the incision site, treatment and prevention of dysrhythmia, pleural effusion and retained blood syndrome, appropriate discharge teaching, following up with the patients after discharge through telephone conversations and post-discharge care.

Reducing readmission after cardiac surgery remains a quality improvement priority. most readmission risk models examine only coronary artery bypass grafting (CABG). So, this study will be carried out to identify predictors of patients' postoperative readmission after cardiac surgery, including CABG \& valvular surgeries.

Eligibility criteria: Inclusion Criteria:

* The study will include a sample of 121 adult patients (male and female) who are undergoing CABG or Cardiac Valvular surgeries and whose age is from 18 to 65 years old.

Exclusion Criteria:

* Failed surgery
* Psychiatric patient
* Patient refusal to participate in the study
* Aortic surgeries

Primary outcomes:
measure: detect perioperative risk factors for hospital readmission in patients whose undergoing cardiac surgeries
timeFrame: baseline
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: Assistant professor of medical surgical nursing
name: Marwa Ali Almasry, Ass.Prof
role: STUDY_DIRECTOR
References:
citation: Iribarne A, Chang H, Alexander JH, Gillinov AM, Moquete E, Puskas JD, Bagiella E, Acker MA, Mayer ML, Ferguson TB, Burks S, Perrault LP, Welsh S, Johnston KC, Murphy M, DeRose JJ, Neill A, Dobrev E, Baio KT, Taddei-Peters W, Moskowitz AJ, O'Gara PT. Readmissions after cardiac surgery: experience of the National Institutes of Health/Canadian Institutes of Health research cardiothoracic surgical trials network. Ann Thorac Surg. 2014 Oct;98(4):1274-80. doi: 10.1016/j.athoracsur.2014.06.059. Epub 2014 Aug 28.
citation: Seifert PC. Reducing Readmissions After Coronary Artery Bypass Grafting. AORN J. 2017 Oct;106(4):332-337. doi: 10.1016/j.aorn.2017.08.009. No abstract available.
citation: Ferraris VA, Ferraris SP, Harmon RC, Evans BD. Risk factors for early hospital readmission after cardiac operations. J Thorac Cardiovasc Surg. 2001 Aug;122(2):278-86. doi: 10.1067/mtc.2001.114776.
citation: Demissie, D. B., Doge, G., & Werba, T. B. (2023). The Magnitude of 30-Day Readmission and Factors Associated with Patients Underwent Cardiac Surgery in Tikur Anbessa Specialized Hospital Cardiac Center, Ethiopia. Research Reports in Clinical Cardiology, Volume 14, 35-48. https://doi.org/10.2147/rrcc.s407183
citation: Stephens RS, Whitman GJ. Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care. Crit Care Med. 2015 Jul;43(7):1477-97. doi: 10.1097/CCM.0000000000001059.