Hospital Readmission After Perioperative AMI

Study Questions:

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

Methods:

A total of 3,807,357 hospitalizations for noncardiac surgery were identified from the 2014 Nationwide Readmission Database. Perioperative AMI was determined by documentation of International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes for acute ST-segment elevation MI (STEMI) or non-STEMI (NSTEMI). Among survivors of index hospitalization, 30-day hospital readmission incidence was determined. Long-term outcomes were examined in the subgroup admitted between January-June 2014, in whom 6-month postoperative data were available.

Results:

Among 3,807,357 surgical hospitalizations from 2014, AMI occurred in 8,085 patients (0.2%). Coronary revascularization was performed in 30% versus 12.5% of STEMI versus NSTEMI cases. Mortality during index hospitalization was 14.0% versus 0.3%, with versus without AMI.

Among index hospitalization survivors, 30-day readmission and overall hospital mortality were 19.1% and 15.9% versus 6.5% and 0.5%, in cases with versus without perioperative AMI. The most common indications for 30-day readmission among AMI survivors were infectious, cardiovascular, and bleeding complications. Subsequent AMI occurred in 11%. Index hospitalization costs were $28,874 versus $11,052, and median length of stay was 9 versus 3 days, with versus without perioperative AMI.

From the subpopulation hospitalized between January-June 2014, those with AMI had 42.4% readmission and 17.6% mortality rates during index or re-hospitalization within 6 months.

Conclusions:

These findings showed that nearly one in three patients with documented perioperative AMI died or were readmitted within 30 days, and that nearly one in two died or were readmitted within 6 months.

Perspective:

Consistent association between perioperative AMI, adverse cardiovascular events, and hospital mortality has been demonstrated previously. However, these new findings provide novel insight into the insidious trajectory of morbidity and significant costs affecting the survivors over time. Proactive efforts to identify perioperative AMI could provide an opportunity to improve outcomes, if intensified monitoring and early aggressive intervention strategies were prioritized for this high-risk population.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Acute Coronary Syndrome, Hospital Costs, Hospital Mortality, Length of Stay, Myocardial Infarction, Myocardial Revascularization, Patient Outcome Assessment, Patient Readmission, Perioperative Period, Surgical Procedures, Operative, Survivors


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