Implementation of Best Practice Guidelines as an Effort in Reducing Hospital Readmission following Coronary Artery Bypass Surgery-Reference-Cited by-同舟云学术

Implementation of Best Practice Guidelines as an Effort in Reducing Hospital Readmission following Coronary Artery Bypass Surgery

Published:2021-09-16 Issue: Volume: Page:1-9
ISSN:0014-312X
Container-title:European Surgical Research
language:en
Short-container-title:Eur Surg Res

Author:

Dinic Dragana^ORCID,Milojevic Milan^ORCID,Paunic Natasa,Cirkovic Andja,Peric Miodrag,Bojic Milovan,Otasevic Petar^ORCID

Abstract

Objectives: The present study aimed to identify significant causes of readmission within 30 days following coronary artery bypass graft (CABG) surgery and compare readmission incidence related to surgical site infections (SSIs) before and after implementing international recommendations for antibiotic prophylaxis. Methods: We analyzed 2,225 CABG patients who received either guideline-directed antibiotic prophylaxis (GDAP = 568) or institutional antibiotic prophylaxis (non-GDAP = 1,657) between January 2017 and December 2019. The primary outcome was a composite of sternal wound infection (SWI) or harvest SWI. Secondary outcomes consisted of the individual components of composite end point, the incidence of in-hospital SSIs, and prolonged postoperative length of hospital stay (LOS) (>7 days). Propensity matching was used to select pairs for final comparison. Results: Before implementing GDAP, the most frequent reason for readmission were SSIs, causing 58.2% of all readmissions within 30 days. Of 429 matched pairs, 48 patients in the GDAP group and 67 patients in the non-GDAP group were readmitted to a hospital within 30 days for any cause (11.2 vs. 15.6%, p = 0.048). We found a decreased readmission incidence for reasons related to SSIs, although these differences did not reach statistical significance (7.4 vs. 10.0%, p = 0.069). Adherence to GDAP was associated with reduced in-hospital risks of SSIs and prolonged postoperative LOS (19.6 vs. 26.6%, p = 0.015). Conclusions: In this contemporary clinical practice study, the adherence to GDAP was an insufficient measure to decrease rehospitalization due to SSIs. The present findings warrant further investigation on factors that may contribute to SSIs development after hospital discharge.

Publisher

S. Karger AG

Subject

Surgery

Reference22 articles.

1. Shah RM, Zhang Q, Chatterjee S, Cheema F, Loor G, Lemaire SA, et al. Incidence, cost, and risk factors for readmission after coronary artery bypass grafting. Ann Thorac Surg. 2019;107(6):1782–9.

2. Shahian DM, He X, O’Brien SM, Grover FL, Jacobs JP, Edwards FH, et al. Development of a clinical registry-based 30-day readmission measure for coronary artery bypass grafting surgery. Circulation. 2014;130(5):399–409.

3. Hannan EL, Racz MJ, Walford G, Ryan TJ, Isom OW, Bennett E, et al. Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 2003;290(6):773–80.

4. Stewart RD, Campos CT, Jennings B, Lollis SS, Levitsky S, Lahey SJ. Predictors of 30-day hospital readmission after coronary artery bypass. Ann Thorac Surg. 2000;70(1):169–74.

5. Kilic A, Magruder JT, Grimm JC, Dungan SP, Crawford T, Whitman GJ, et al. Development and validation of a score to predict the risk of readmission after adult cardiac operations. Ann Thorac Surg. 2017;103(1):66–73.