Abstract 12681: Determinants of Prolonged Hospital Stay for Patients Undergoing Revascularization: The ASCERT Study

Autor: Zugui Zhang, Fred Edwards, Paul Kolm, Maria Grau-Sepulveda Maria Grau-Sepulveda, Sean O'Brien, David Shahian, Angelo Ponirakis, Lloyd W Klein, Frederick L Grover, Kirk N Garratt, Charles Mckay, William S Weintraub
Rok vydání: 2015
Předmět:
Zdroj: Circulation. 132
ISSN: 1524-4539
0009-7322
DOI: 10.1161/circ.132.suppl_3.12681
Popis: Background: Prolonged hospital stay (PHS) has been a costly health care issue. Using data from the Society of Thoracic Surgeons (STS) Database and the American College of Cardiology Foundation (ACCF) National Cardiovascular Data Registry (NCDR) in ASCERT, we examined the determinants of PHS in a 30-day period after the index hospitalization for patients undergoing coronary-artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Methods: The STS Database and ACCF NCDR were linked to the Centers for Medicare and Medicaid Services claims data from years 2004 to 2008 for patients who were age ≥65 years with stable 2 and 3-vessel disease undergoing revascularization. The length of stay >7 days in CABG and >2 days in PCI patients was defined as PHS, respectively; the determinants of PHS in a 30-day period after the index hospitalization for CABG and PCI patients were examined. Results: By 30 days, 40,694 (47.18%) of 86,244 in CABG group and 32,789 (31.67%) of 103,549 in PCI group had PHS. Of those, 7,000(17.2%) and 13,721(33.72%) were diagnosed with congestive heart failure (CHF) and unstable angina in CABG, respectively; among PCI patients, 6491 (19.8%) and 18,397 (56.11%) were diagnosed with CHF and unstable angina, respectively. We found that advanced age, gender, race, body mass index, smoking status, stroke, angina status, left ventricular ejection fraction, number of diseased vessels (2 vs 3 or more), CHF, chronic lung disease, CVD, peripheral vascular disease, diabetes, GFR, renal failure, and procedure status were significantly associated with PHS for both groups; previous MI and family CAD history were associated with PHS in CABG group (c-index=0.70) but not in PCI group; AMI, previous PCI, and discharge medication were associated with PHS in PCI group (c-index=0.75) but not in CABG group. Adjusted by other risk factors, PHS was less likely after PCI (odds ratio: 0.46, 95% CI: 0.44 to 0.49, c-index=0.76). Conclusions: Determinants of PHS were significantly related to specified pre-, intra- and postoperative risk factors for CABG and PCI patients in 30 days after index-hospitalization. This analysis that linked large clinical and administrative databases can be applied to inform shared decision making between providers and patients.
Databáze: OpenAIRE
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