30-day readmission for patients undergoing percutaneous coronary interventions in New York state.

ABSTRACT

OBJECTIVES: This study sought to report percutaneous coronary intervention (PCI) 30-day readmission rates, identify the impact of staged (planned) readmissions on overall readmission rates, determine the significant predictors of unstaged readmissions after PCI, and specify the reasons for readmissions. BACKGROUND: Hospital readmissions occur frequently and incur substantial costs. PCI are among the most common and costly procedures, and little is known about the nature and extent of readmissions for PCI. METHODS: We retrospectively analyzed 30-day readmissions after PCI using the nation's largest statewide PCI registry to identify 40,093 New York State patients who underwent PCI between January 1, 2007, and November 30, 2007. Demographic variables, pre-procedural risk factors, complications of PCI, and length of stay were considered as potential predictors of readmission, and reasons for readmission were identified from New York's administrative database using principal diagnoses. RESULTS: A total of 15.6% of all PCI patients were readmitted within 30 days, and 20.6% of these readmissions were staged. Among unstaged readmissions, the most common reasons for readmission were chronic ischemic heart disease (22.5%), chest pain (10.8%), and heart failure (8.2%). A total of 2,015 patients (32.2% of readmissions) underwent a repeat PCI. Thirteen demographic and diagnostic risk factors, as well as longer lengths of stay, were all associated with higher readmission rates. CONCLUSIONS: Future efforts to reduce readmissions should be directed toward the recognition of patients most at risk, and the reasons they are readmitted. Staging also should be examined from a cost-effectiveness standpoint as a function of patients' unique risk factors.