B. Kavianpour1,2, Y. Sanaiha1, H. Khoury1, S. E. Rudasill1, R. Jaman1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2Stony Brook University School of Medicine,Department of Medicine,Stony Brook, NY, USA
Introduction:
With increasing dissemination and improved survival following of extracorporeal membrane oxygenation (ECMO), readmission reduction following ECMO hospitalization is a imminent priority. Early readmissions following hospitalization requiring ECMO have not been characterized at the national level. The present study aimed to identify predictors of early readmission in the largest, all-payer national discharge database.
Methods:
This was a retrospective cohort study using the Nationwide Readmissions Database to identify all adult patients (>=18 years) who underwent ECMO from 2010-2015 and survived index hospitalization. Patients were stratified as requiring ECMO for cardiac or respiratory etiologies. Cardiac ECMO included post-cardiotomy and cardiogenic shock patients while respiratory patients had no other concurrent cardiac diagnosis. All heart and lung transplant patients were excluded. The primary outcome of the study was early (30-day) rehospitalization after index ECMO encounter. Univariate analyses were performed for age, Elixhauser comorbidity index, and cost of readmission. A multivariable logistic regression model was developed to predict the odds of urgent 30-day readmission.
Results:
Of an estimated 9,391 discharged patients who underwent ECMO, 4,352 (46.3%) required ECMO for primary cardiac indications while 3,669 (39.1%) required ECMO for primary respiratory failure. Unplanned readmission within 30 days of discharge was similar across both cardiovascular and respiratory ECMO groups (18.3 vs 16.2%, P=0.20). Readmission status was not associated with age in both patient populations (Cardiac: 60.2 vs. 58.8 years, P=0.19; Respiratory: 46.0 vs. 43.5 years, P=0.06). Readmitted patients had higher comorbidity score for cardiac indications but not for respiratory indications compared to the non-readmitted cohort (Cardiac: 5.8 vs. 5.2, P<0.01; Respiratory: 5.0 vs. 4.9, P=0.77). Coronary artery disease (CAD) was a significant predictor of readmission within 30 days for both cardiac and respiratory indications (Table 1). Renal failure and bleeding were significant predictors of readmission for cardiac indications while a prolonged length of stay (> 10 days) and infection were significant predictors for respiratory indications. The mean cost of urgent 30-day readmission was $174,713.40 (SE $10,280.97) for cardiac ECMO and $242,422.3 (SE $12.632.89) for respiratory ECMO.
Conclusion:
CAD, renal failure, and complications, such as bleeding and infection, during ECMO place patients at the highest risk for readmission within 30 days. Given the high costs of readmission following ECMO, attention to processes of discharge and outpatient care for this vulnerable population is warranted.
