Infection-related Hospital Readmissions after Heart Transplantation

Author(s):
Georgia Vasileiou; Joshua Parreco; Michelle Mulder; Sarah Eidelson; Valerie Hart; Daniel Yeh; Nicholas Namias; Rishi Rattan

Background:

There are no national studies on heart transplant (HTx) readmissions that include different hospital readmission. Postoperative different hospital readmission occurs in up to one third of patients, with infection a common cause. We examined infection-related readmissions, including to different hospitals, of HTx recipients nationwide.

Methods:

The 2010-2014 Nationwide Readmissions Database was queried for 30-day (30d) and 1-year (1y) readmission rates after HTx. Using ICD-9 principal diagnosis codes, subgroup analysis of the patients readmitted within one year with infection was performed. Multivariate regression analysis identified readmission risk factors.

Results:

Of 9,840 patients undergoing HTx, readmission rate was 21% (n=2,070) at 30d and 41% (n=4,082) at 1y. Readmission risk factors are reported in Table 1 and included lowest income quartile and Medicare. Of note, private insurance was the primary payer for 48% (n=4,722). HTx-related complications were the most common reason for readmission at 30d (30%) and 1y (26%) followed by infection (16% and 21%, respectively). Notably, infection was the most common reason for readmission to a different hospital within 1y (19.2%). Independent risk factors for infectious 1y readmission are reported in Table 2 and include: index admission to a public hospital and Medicaid.

Conclusions:

Postoperative infections, a core quality indicator, are a major cause of post-HTx readmission. Further, infection was the most common reason for readmission to a different hospital and these patients are missed by current quality metrics. Risk factors included hospital type and socioeconomic factors and are distinct from risk factors for readmission overall. These findings have implications for the accuracy of outcomes measurement, reimbursement, and interventions designed to prevent fragmentation of care.