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Day of discharge does not influence heart surgery patient readmissions

The use of preoperative beta blockers, tobacco use, and surgical site infections were independent predictors of readmission within 30 days.

Jeff Lagasse, Associate Editor

Despite a common belief that weekend and holiday discharge after major heart surgery may impact hospital readmissions, research published in The Annals of Thoracic Surgery showed that day of discharge does not affect readmissions.

IMPACT

Researchers reviewed data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database for all patients who underwent non-emergency heart operations between 2008 and 2016 at Ronald Reagan UCLA Medical Center. They identified 4,877 patients, of whom nearly 20 percent were discharged on a weekend or holiday.

This subset was particularly important because of the so-called "weekend effect," which has been described as worse outcomes attributed to decreased staffing and increased transitions of care.

They found that the use of preoperative beta blockers, tobacco use, and surgical site infections were independent predictors of readmission within 30 days, but day of discharge was not. The study showed comparable readmission rates for weekday and weekend/holiday discharges (11.4 percent versus 10.9 percent).

Discovering that patients discharged on weekends and holidays had similar readmission rates and outcomes as those who were cleared on weekdays came as something of a surprise. They credit much of this to the Readmission Reduction Program.

UCLA launched the program in 2010. It includes discharge education, detailed medication instructions, postoperative care coordination and routine phone calls for four weeks after discharge.

THE TREND

Readmissions are a thorn in the side of many hospitals across the county, as the Centers for Medicare and Medicaid Services decrease Medicare payments to facilities that underperform on the 30-day readmission metric in comparison to their peers. By law, hospitals can be penalized up to 3 percent of their reimbursements.

Certain states are feeling the impact. A large percentage of California hospitals are being hit by Medicare reimbursement penalties, and facilities in Connecticut aren't faring much better, with 93 percent of that state's hospitals being penalized effective October 1, the start of the fiscal year.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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