G. Ramos1, R. Kashani1, Y. Juo1, A. Lin2, N. Satou1, R. J. Shemin1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Division Of Cardiac Surgery,Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles,Division of General Surgery,Los Angeles, CA, USA
Introduction: Unintended rehospitalization within 30 days serves as a quality metric for institutions and may lead to financial penalties. Few studies have examined the implications of weekend discharges on readmission rates. Limited care coordination and cross coverage of surgeons are known challenges of weekend hospital function and may lead to less comprehensive post-discharge care plan. Based on this knowledge, we hypothesized that patients discharged on weekends would be more likely to be readmitted.
Methods: Using the institutional Society of Thoracic Surgeons (STS) database, all adult patients (>18) undergoing cardiac surgery between 2008 and 2015 were identified. 44 demographic and perioperative characteristics were collected and accounted for in a multivariate model. Emergency, transplant and mechanical assist patients were excluded. Weekday discharge was defined as being discharged on Monday through Friday while weekend discharge was limited to Saturdays and Sundays. The primary outcome variable was any readmission within 30 days of discharge.
Results: Of the 4416 patients included in the study, 3632 (82%) were discharged on a weekday, and 783 (18%) were discharged on a weekend; 495 (11%) patients were readmitted within 30 days. The readmission rates for the weekday and weekend cohorts were similar (10% vs.11%, p=0.4). After adjustment for other risk factors of readmission, there was no association between discharge day of the week and readmission (adjusted odds ratio [AOR]= 1.08, 95% CI=0.83-1.42, p=0.6). Significant risk factors for readmission included receiving dialysis (AOR=1.6, 95% CI=1.09-2.30, p=0.016), undergoing an urgent operation (AOR=1.24, 95% CI=1.01-1.53, p=0.04), and taking preoperative Coumadin (AOR=1.43, 95% CI=1.04-1.97, p=0.03) or beta-blockers (AOR=1.32, 95% CI=1.07-1.63, p=0.01).
Conclusion: In this study, weekend discharge status was not associated with an increased risk of readmission after cardiac surgery. However, patients having an urgent surgery, receiving dialysis, or taking preoperative Coumadin or beta-blockers were more likely to be readmitted. Our findings suggest that readmission reduction programs should focus on patient factors rather than providing additional weekend coverage beyond existing care coordination resources.