Thirty-Day Readmission Rate and Costs After Percutaneous Coronary Intervention in the United States: A National Readmission Database Analysis

• Published in: Circulation. Cardiovascular interventions Vol. 10; no. 12
• Main Authors: Tripathi, Avnish, Abbott, J Dawn, Fonarow, Gregg C, Khan, Abdur R, Barry, 4th, Neil G, Ikram, Sohail, Coram, Rita, Mathew, Verghese, Kirtane, Ajay J, Nallamothu, Brahmajee K, Hirsch, Glenn A, Bhatt, Deepak L
• Format: Journal Article
• Language: English
• Published: United States 01.12.2017
• Subjects: Adolescent; Adult; Aged; Angina Pectoris - economics; Angina Pectoris - epidemiology; Chi-Square Distribution; Coronary Disease - economics; Coronary Disease - mortality; Coronary Disease - therapy; Databases, Factual; Female; Hospital Costs; Hospital Mortality; Humans; Linear Models; Logistic Models; Male; Medicare - economics; Middle Aged; Models, Economic; Multivariate Analysis; Patient Readmission - economics; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - economics; Percutaneous Coronary Intervention - mortality; Process Assessment (Health Care) - economics; Risk Factors; Time Factors; Treatment Outcome; United States - epidemiology; Young Adult; heart failure; percutaneous coronary intervention; inpatients; coronary artery bypass; chest pain
• ISSN: 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.117.005925

The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. We evaluated 206 869 hospitalized patients who survived to discharge after PCI from January through November 2013 and analyzed readmissions over 30 days after discharge. A total of 24 889 patients (12%) were readmitted within 30 days, with rates ranging from 6% to 17% across hospitals. Among the readmitted patients, 13% had PCI, 2% had coronary artery bypass surgery, and 3% died during the readmission. The most common reasons for readmission included nonspecific chest pain/angina (24%) and heart failure (11%). Mean cumulative costs were higher for those with readmissions ($39 634 versus $22 058; <0.001). The multivariable analyses showed that readmission increased the log cumulative costs by 45% (β: 0.445; <0.001). There was no significant difference in cumulative costs by the type of insurance. In a national sample of inpatient PCI cases, 30-day readmissions were associated with a significant increase in cumulative costs. The majority of readmissions were because of low-risk chest pain that did not require any intervention. Ongoing effort is warranted to recognize and mitigate potentially preventable post-PCI readmissions.