Effects of acute-phase multidisciplinary rehabilitation on unplanned readmissions after cardiac surgery

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 161; no. 5; pp. 1853 - 1860.e2
• Main Authors: Ogawa, Masato, Satomi-Kobayashi, Seimi, Yoshida, Naofumi, Tsuboi, Yasunori, Komaki, Kodai, Wakida, Kumiko, Gotake, Yasuko, Izawa, Kazuhiro P., Sakai, Yoshitada, Okada, Kenji
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021
• Subjects: acute phase; cardiac surgery; multidisciplinary cardiac rehabilitation; propensity score; readmission; readmission; AF; CI; Conv-CR; HR; CR; QOL; Multi-CR; acute phase; cardiac surgery; multidisciplinary cardiac rehabilitation; propensity score; BMI
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2019.11.069

The provision of inpatient programs that reduce the incidence of readmission after cardiac surgery remains challenging. Investigators have focused on multidisciplinary cardiac rehabilitation (CR) because it reduces the postoperative readmission rate; however, most previous studies used outpatient models (phase II CR). We retrospectively investigated the effect of comprehensive multidisciplinary interventions in the acute inpatient phase (phase I CR) on unplanned hospital readmission. In a retrospective cohort study, we compared consecutive patients after cardiac surgery. We divided them into the multidisciplinary CR (multi-CR) group or conventional exercise-based CR (conv-CR) group according to their postoperative intervention during phase I CR. Multi-CR included psychological and educational intervention and individualized counseling in addition to conv-CR. The primary outcome was unplanned readmission rates between the groups. A propensity score–matching analysis was performed to minimize selection biases and the differences in clinical characteristics. In our cohort (n = 341), 56 (18.3%) patients had unplanned readmission during the follow-up period (median, 419 days). Compared with the conv-CR group, the multi-CR group had a significantly lower unplanned readmission rate (multivariable regression analysis; hazard ratio, 0.520; 95% confidence interval, 0.28-0.95; P = .024). A Kaplan–Meier analysis of our propensity score–matched cohort showed that, compared with the conv-CR group, the multi-CR group had a significantly lower incidence of readmission (stratified log-rank test, P = .041). In phase I, compared to conv-CR alone, multi-CR reduced the incidence of unplanned readmission. Early multidisciplinary CR can reduce hospitalizations and improve long-term prognosis after cardiac surgery. [Display omitted]