Independent Predictors of Readmission following Left-Atrial-Appendage
Closure: Insights from the Nationwide Readmissions Database
Abstract
Objective To analyze the incidence, predictors, and cost of 30-day left
atrial appendage closure readmissions utilizing the Nationwide
Readmissions Database (NRD) and to develop a scoring system to predict
readmission risk. Background Determining incidence and predictors of
30-day readmission post-left atrial appendage closure can direct
resources towards high-risk patients. Methods International
Classification of Diseases, Tenth Revision (ICD-10) codes were used to
identify patients. We excluded patients who were discharged or died in
December 2016. Influential factors were identified by univariate
analysis and clinical suspicion. Continuous variables were compared
using the Student’s T-test and categorical variables were compared using
chi-square or Fisher’s exact test. A logistic regression model and
scoring system were developed and validated. Results 2975 patients were
identified and 243 (8.2%) readmitted within 30 days. Non-routine
disposition (p<0.0001), chronic pulmonary disease (p=0.0003),
renal disease (p<0.0001), and anemia (p=0.009) were
significant predictors of readmission. Readmitted patients had longer
lengths of stay (2.8 days ± 4.8) and higher charges ($139,869.3 ±
94,574.3). Average length of stay and cost for rehospitalizations were
4.8 days ±4.9 and $62,577± 85,850. Top causes of readmission included
atrial fibrillation, atrial flutter, congestive heart failure, sepsis
and gastrointestinal bleeding. Mortality during rehospitalization was
1.2%. Our scoring system had a C-statistic of 0.679 (derivation) and
0.633 (validation). Conclusion Readmitted patients have longer and more
expensive initial hospital admissions, and chronic cardiac, pulmonary,
and renal issues. A simple scoring system may identify patients at risk
for readmission