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National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999-2010.

Dodson JA, Wang Y, Murugiah K, Dharmarajan K, Cooper Z, Hashim S, Nuti SV, Spatz E, Desai N, Krumholz HM - PLoS ONE (2015)

Bottom Line: The post-MVS 1-year readmission rate declined from 1999-2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01).Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission.There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.

View Article: PubMed Central - PubMed

Affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.

ABSTRACT

Background: Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals.

Methods: We included 100% of Medicare Fee-for-Service patients ≥65 years of age who underwent MVS between 1999-2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race).

Results: The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999-2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65-74: 47.4% to 44.4%; 75-84: 51.4% to 49.2%, ≥85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18).

Conclusions: Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.

No MeSH data available.


Related in: MedlinePlus

Risk-adjusted annual odds of readmission in patients surviving 1 year after mitral valve surgery, 1999–2010 (overall and by subgroups).
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pone.0132470.g002: Risk-adjusted annual odds of readmission in patients surviving 1 year after mitral valve surgery, 1999–2010 (overall and by subgroups).

Mentions: Among age subgroups, patients ≥85 years were the most likely to be readmitted within 1 year during all years of observation. Observed readmission rates [95% CI] declined in all ages between 1999 and 2010 (65–74: 47.4% [46.1–48.7] to 44.4% [43.0–45.7]; 75–84: 51.4% [50.1–52.8] to 49.2% [47.8–50.6]; ≥85: 56.4% [51.5–61.2] to 50.0% [41.2–53.8]) (Table A in S1 File). Women were more likely to experience 1-year readmission than men, although declines were seen in both groups (women: 51.7% [50.5–53.0] to 50.8% [49.5–52.1]; men: 46.9% [45.6–48.3] to 43.0% [41.7–44.3]). Among race subgroups, black patients had the highest 1-year readmission rates, and there was no decline in observed 1-year readmission over time (58.1% [53.1–62.9] to 59.0% [54.6–63.4]). Among patients of white and other races there were declines in 1-year readmission rates (white: 49.0% [48.1–50.0] to 46.2% [45.2–47.2]; other: 55.0% [49.4–60.4] to 48.9% [44.3–53.6]). The above findings did not change substantially after accounting for patient characteristics and within and between-hospital sources of variation, except for black patients, which after adjustment showed a statistically significant decline. Overall, the adjusted annual decline was 2.3% (95% CI 1.6 to 3.0). Fig 2 shows the adjusted annual decline in 1-year readmission by age-gender-race subgroup and overall.


National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999-2010.

Dodson JA, Wang Y, Murugiah K, Dharmarajan K, Cooper Z, Hashim S, Nuti SV, Spatz E, Desai N, Krumholz HM - PLoS ONE (2015)

Risk-adjusted annual odds of readmission in patients surviving 1 year after mitral valve surgery, 1999–2010 (overall and by subgroups).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493110&req=5

pone.0132470.g002: Risk-adjusted annual odds of readmission in patients surviving 1 year after mitral valve surgery, 1999–2010 (overall and by subgroups).
Mentions: Among age subgroups, patients ≥85 years were the most likely to be readmitted within 1 year during all years of observation. Observed readmission rates [95% CI] declined in all ages between 1999 and 2010 (65–74: 47.4% [46.1–48.7] to 44.4% [43.0–45.7]; 75–84: 51.4% [50.1–52.8] to 49.2% [47.8–50.6]; ≥85: 56.4% [51.5–61.2] to 50.0% [41.2–53.8]) (Table A in S1 File). Women were more likely to experience 1-year readmission than men, although declines were seen in both groups (women: 51.7% [50.5–53.0] to 50.8% [49.5–52.1]; men: 46.9% [45.6–48.3] to 43.0% [41.7–44.3]). Among race subgroups, black patients had the highest 1-year readmission rates, and there was no decline in observed 1-year readmission over time (58.1% [53.1–62.9] to 59.0% [54.6–63.4]). Among patients of white and other races there were declines in 1-year readmission rates (white: 49.0% [48.1–50.0] to 46.2% [45.2–47.2]; other: 55.0% [49.4–60.4] to 48.9% [44.3–53.6]). The above findings did not change substantially after accounting for patient characteristics and within and between-hospital sources of variation, except for black patients, which after adjustment showed a statistically significant decline. Overall, the adjusted annual decline was 2.3% (95% CI 1.6 to 3.0). Fig 2 shows the adjusted annual decline in 1-year readmission by age-gender-race subgroup and overall.

Bottom Line: The post-MVS 1-year readmission rate declined from 1999-2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01).Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission.There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.

View Article: PubMed Central - PubMed

Affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.

ABSTRACT

Background: Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals.

Methods: We included 100% of Medicare Fee-for-Service patients ≥65 years of age who underwent MVS between 1999-2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race).

Results: The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999-2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65-74: 47.4% to 44.4%; 75-84: 51.4% to 49.2%, ≥85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18).

Conclusions: Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks.

No MeSH data available.


Related in: MedlinePlus