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

Avnish Tripathi, J. Dawn Abbott, Gregg C. Fonarow, Abdur R. Khan, Neil G. Barry, Sohail Ikram, Rita Coram, Verghese Mathew, Ajay J. Kirtane, Brahmajee K. Nallamothu, Glenn A. Hirsch, Deepak L. Bhatt

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background-The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. Methods and Results-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; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45% (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. Conclusions-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.

Original languageEnglish (US)
Article numbere005925
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Databases
Costs and Cost Analysis
Chest Pain
Health Care Costs
Insurance
Coronary Artery Bypass
Inpatients
Heart Failure
Regression Analysis

Keywords

  • chest pain
  • coronary artery bypass
  • heart failure
  • inpatients
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thirty-Day Readmission Rate and Costs after Percutaneous Coronary Intervention in the United States : A National Readmission Database Analysis. / Tripathi, Avnish; Abbott, J. Dawn; Fonarow, Gregg C.; Khan, Abdur R.; Barry, Neil G.; Ikram, Sohail; Coram, Rita; Mathew, Verghese; Kirtane, Ajay J.; Nallamothu, Brahmajee K.; Hirsch, Glenn A.; Bhatt, Deepak L.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 12, e005925, 01.12.2017.

Research output: Contribution to journalArticle

Tripathi, A, Abbott, JD, Fonarow, GC, Khan, AR, Barry, NG, Ikram, S, Coram, R, Mathew, V, Kirtane, AJ, Nallamothu, BK, Hirsch, GA & Bhatt, DL 2017, 'Thirty-Day Readmission Rate and Costs after Percutaneous Coronary Intervention in the United States: A National Readmission Database Analysis', Circulation: Cardiovascular Interventions, vol. 10, no. 12, e005925. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005925
Tripathi, Avnish ; Abbott, J. Dawn ; Fonarow, Gregg C. ; Khan, Abdur R. ; Barry, Neil G. ; Ikram, Sohail ; Coram, Rita ; Mathew, Verghese ; Kirtane, Ajay J. ; Nallamothu, Brahmajee K. ; Hirsch, Glenn A. ; Bhatt, Deepak L. / Thirty-Day Readmission Rate and Costs after Percutaneous Coronary Intervention in the United States : A National Readmission Database Analysis. In: Circulation: Cardiovascular Interventions. 2017 ; Vol. 10, No. 12.
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abstract = "Background-The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. Methods and Results-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; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45{\%} (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. Conclusions-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.",
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T1 - Thirty-Day Readmission Rate and Costs after Percutaneous Coronary Intervention in the United States

T2 - A National Readmission Database Analysis

AU - Tripathi, Avnish

AU - Abbott, J. Dawn

AU - Fonarow, Gregg C.

AU - Khan, Abdur R.

AU - Barry, Neil G.

AU - Ikram, Sohail

AU - Coram, Rita

AU - Mathew, Verghese

AU - Kirtane, Ajay J.

AU - Nallamothu, Brahmajee K.

AU - Hirsch, Glenn A.

AU - Bhatt, Deepak L.

PY - 2017/12/1

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N2 - Background-The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. Methods and Results-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; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45% (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. Conclusions-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.

AB - Background-The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. Methods and Results-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; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45% (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. Conclusions-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.

KW - chest pain

KW - coronary artery bypass

KW - heart failure

KW - inpatients

KW - percutaneous coronary intervention

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