Hospital Readmissions After Perioperative AMI

Study Questions:

What are the frequency, causes, and outcomes of 30-day hospital readmission after perioperative acute myocardial infarction (AMI)?

Methods:

The investigators identified patients who were diagnosed with AMI during hospitalization for major noncardiac surgery using the 2014 United States Nationwide Readmission Database. Rates, causes, and costs of 30-day readmissions after noncardiac surgery with and without perioperative AMI were identified. Multivariable logistic regression models were generated to estimate odds ratios adjusted for patient demographics, cardiovascular risk factors, and comorbidities.

Results:

Among 3,807,357 hospitalizations for major noncardiac surgery, 8,085 patients with perioperative AMI were identified. A total of 1,135 perioperative AMI patients (14.0%) died in-hospital during the index admission. Survivors of perioperative AMI were more likely to be readmitted within 30 days than surgical patients without perioperative AMI (19.1% vs. 6.5%, p < 0.001). The most common indications for 30-day rehospitalization were management of infectious complications (30.0%), cardiovascular complications (25.3%), and bleeding (10.4%). In-hospital mortality during hospital readmission in the first 30 days after perioperative AMI was 11.3%. At 6 months, the risk of death was 17.6% and ≥1 hospital readmission was 36.2%.

Conclusions:

The authors concluded that among patients undergoing noncardiac surgery who develop a perioperative MI, approximately one in three suffer from in-hospital death or hospital readmission in the first 30 days after discharge.

Perspective:

This analysis from a large national readmission database of adults admitted for major noncardiac surgery reports that nearly one-third of patients identified as having perioperative AMI died during the index hospitalization or were readmitted within 30 days of discharge, and one half of the patients died or were readmitted by 6 months. These data suggest that mortality among perioperative AMI patients poses a significant burden to the healthcare system and we need strategies to improve outcomes of surgical patients early after perioperative AMI. The optimal prevention and management of patients with perioperative AMI remains uncertain, and medical interventions or systems of care to reduce death and hospital readmissions in this population need to be better defined.

Clinical Topics: Acute Coronary Syndromes, Prevention

Keywords: ACC18, ACC Annual Scientific Session, Acute Coronary Syndrome, Hemorrhage, Hospital Mortality, Myocardial Infarction, Patient Discharge, Patient Readmission, Perioperative Period, Primary Prevention, Risk Factors, Surgical Procedures, Operative


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