Readmission Following Pediatric Cardiothoracic Surgery: An analysis of the Society of Thoracic Surgeons Database

Abstract Background Hospital readmission after pediatric cardiac surgery is incompletely understood. We analyzed data from the STS Congenital Heart Surgery database (STS-CHSD) to determine prevalence, to describe patient characteristics, and to evaluate risk factors for readmission. Methods Readmission was defined by the "readmission within 30 days after discharge" field. Routine variables were summarized. Regression analysis was used to identify factors associated with readmission. Results The study cohort included 56,429 patient records from 100 centers. Overall, 6,208 (11%) patients were readmitted. The most common reasons for readmission were respiratory/airway complications (14.2%), septic/infectious complications (11.4%), and reasons not related to the preceding surgical procedure (20.2%). Primary reason for readmission varied across benchmark operation groups. In multivariable analysis, factors associated with increased odds of readmission included the presence of non-cardiac abnormalities (OR = 1.24), chromosomal abnormalities and/or genetic syndromes (OR = 1.24), preoperative mechanical circulatory support (OR = 1.36), other preoperative factors (OR = 1.21), prior cardiac surgery (OR = 1.31), Hispanic ethnicity (OR = 1.13), higher procedural complexity (STAT level 3 versus 1; OR=1.22, STAT 4 vs 1; OR=1.48, STAT 5 vs 1; OR=2.62), prolonged post-operative length of stay (OR = 1.07 per day 0-14 days; OR=1.01 per week >14 days), any major complication (OR = 1.27), any other postoperative complications (OR = 2.00), and discharge on a weekday (OR = 1.07). Conclusions Readmission is common after congenital heart surgery, mostly for non-cardiovascular reasons. Process improvement initiatives targeted at high-risk patients might minimize its impact.