Ninety-Day Readmission After Open Surgical Repair of Stanford Type A Aortic Dissection

• Published in: The Annals of thoracic surgery Vol. 113; no. 6; pp. 1971 - 1978
• Main Authors: Amin, Arsalan, Ghanta, Ravi K., Zhang, Qianzi, Zea-Vera, Rodrigo, Rosengart, Todd K., Preventza, Ourania, LeMaire, Scott A., Coselli, Joseph S., Chatterjee, Subhasis
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2022
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2021.06.065

Investigations into readmissions after surgical repair of acute Stanford type A aortic dissection (TAAD) remain scarce. We analyzed potential risk factors for readmission after TAAD. The 2013 to 2014 US Nationwide Readmissions Database was queried for TAAD index hospitalizations and 90-day readmissions indicated by diagnostic and procedural codes. Multivariable analysis was completed to identify risk factors and the most common reasons for readmission. We identified 6975 patients (65% men; mean age, 60.0 ± 0.4 years) who underwent surgical repair for TAAD. Overall 2062 patients (29.6%) were readmitted within 90 days: 634 (30.7%) during the first 30 days and 1428 (69.3%) during days 31 through 90. Readmitted patients had a higher prevalence of chronic kidney disease at index admission (18.0% vs 11.6%, P = .002), greater overall index length of stay (17.8 ± 0.6 vs 15. 5 ± 0.4 days; P = .0003), and greater index hospitalization cost ($90,637 ± $2691 vs $80,082 ± $2091; P = .0003). Mortality during readmission was 3.6% (n = 74). Indications for readmission were most commonly cardiac (26.2%), infectious (17.8%), and pulmonary (11.7%). Multivariate analysis identified 2 independent risk factors for readmission: acute kidney injury (odds ratio, 1.49; 95% confidence interval, 1.24-1.78; P < .0001) and an Elixhauser comorbidity index > 4 (odds ratio, 1.26; 95% confidence interval, 1.06-1.49; P = .009). After surgical repair of TAAD, approximately 30% of patients were readmitted within 90 days, two-thirds of them during the 31- to 90-day period. Targeted improvements in perioperative care and postdischarge follow-up of patients with multiple comorbidities could mitigate readmission rates. Efforts to reduce readmissions should be continued throughout the 90-day period.