Day of Discharge Does Not Impact Hospital Readmission After Major Cardiac Surgery.

Abstract

Because the rate of rehospitalization after major cardiac surgery has been reported up to 22%, an investigation of potential modifiable elements in the discharge process has led our group to evaluate whether the day of discharge affects readmission performance. Our institutional Society of Thoracic Surgeons registry was used to identify all adult patients undergoing elective cardiac operations from 2008 to 2016. Emergency, transplant, and mechanical assist patients were excluded. The primary outcome was all-cause readmission within 30 days of operation. Multivariable logistic regression was used to develop a risk-adjusted predictive model of readmission risk. Of 4,877 patients discharged from our institution, 20% were discharged on a weekend or holiday. The overall rehospitalization rate was 11.3%, with comparable readmission rates for weekday and weekend and holiday discharges (11.4 vs 10.9, p = 0.73). A greater proportion of patients are discharged to facilities on weekdays than on weekends and holidays (15.0% vs 5.7%, p < 0.001). Discharge to a facility is associated with a higher all-cause, unadjusted readmission rate (16.7% vs 12.7%, p = 0.01). After adjusting for patient comorbidities, operative performance, and postoperative complications, weekend or holiday discharge is not associated with worse readmission performance (adjusted odds ratio, 1.0; 95% confidence interval, 0.77 to 1.32). Cardiac surgical patients in the weekend and holiday discharge cohort did not have significantly higher odds of readmission regardless of operative type and discharge disposition. Allocation of resources to changing weekend staffing may be better allocated to surgical site infection prevention and outpatient intervention programs.