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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

Discharge disposition (from index hospitalization) among patients surviving mitral valve surgery to 1 year, 1999–2010.
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pone.0132470.g003: Discharge disposition (from index hospitalization) among patients surviving mitral valve surgery to 1 year, 1999–2010.

Mentions: Mean hospital LOS [SD], excluding the index hospitalization, within the 1 year following MVS discharge decreased from 1999 to 2010 (6.2 [12.8] to 5.3 [11.7] days, P<0.001) (Table C in S1 File). LOS declined among all subgroups of age (65–74: 5.9 [13.3] to 5.0 [11.7] days; 75–84: 6.4 [12.0] to 5.4 [11.6] days; ≥85: 7.8 [14.1] to 6.2 [12.5] days, all P<0.001) and sex (women: 6.8 [13.2] to 5.9 [11.8] days; men: 5.5 [12.2] to 4.6 [11.5] days, all P<0.01). LOS did not decline significantly among black patients (9.9 [17.3] to 9.7 [18.0] days, p = 0.81), but declined among patients of white and other races (white: 6.0 [12.4] to 5.0 [11.1] days; other 7.7 [16.0] to 6.0 [13.7] days, all P<0.01). Between 1999 and 2010, the proportion of patients after MVS discharged directly to home without home care declined (46.5% to 27.5%); more patients were discharged to home with home care (26.5% to 36.3%); and an increasing number were discharged to skilled nursing or rehabilitation facilities (14.7% to 21.5%, all p<0.001 for trend, Fig 3). Over the aggregate study period, patients discharged to a home setting were less likely to experience readmission within 1 year of discharge compared with patients discharged elsewhere (42.0% vs. 58.0%, P<0.001). The percentage of patients who spent more than 30 days in the hospital after discharge was low throughout the study period and declined over time (1999: 4.3% [4.0–4.7]; 2010: 3.4%[3.1–3.8]).


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)

Discharge disposition (from index hospitalization) among patients surviving mitral valve surgery to 1 year, 1999–2010.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132470.g003: Discharge disposition (from index hospitalization) among patients surviving mitral valve surgery to 1 year, 1999–2010.
Mentions: Mean hospital LOS [SD], excluding the index hospitalization, within the 1 year following MVS discharge decreased from 1999 to 2010 (6.2 [12.8] to 5.3 [11.7] days, P<0.001) (Table C in S1 File). LOS declined among all subgroups of age (65–74: 5.9 [13.3] to 5.0 [11.7] days; 75–84: 6.4 [12.0] to 5.4 [11.6] days; ≥85: 7.8 [14.1] to 6.2 [12.5] days, all P<0.001) and sex (women: 6.8 [13.2] to 5.9 [11.8] days; men: 5.5 [12.2] to 4.6 [11.5] days, all P<0.01). LOS did not decline significantly among black patients (9.9 [17.3] to 9.7 [18.0] days, p = 0.81), but declined among patients of white and other races (white: 6.0 [12.4] to 5.0 [11.1] days; other 7.7 [16.0] to 6.0 [13.7] days, all P<0.01). Between 1999 and 2010, the proportion of patients after MVS discharged directly to home without home care declined (46.5% to 27.5%); more patients were discharged to home with home care (26.5% to 36.3%); and an increasing number were discharged to skilled nursing or rehabilitation facilities (14.7% to 21.5%, all p<0.001 for trend, Fig 3). Over the aggregate study period, patients discharged to a home setting were less likely to experience readmission within 1 year of discharge compared with patients discharged elsewhere (42.0% vs. 58.0%, P<0.001). The percentage of patients who spent more than 30 days in the hospital after discharge was low throughout the study period and declined over time (1999: 4.3% [4.0–4.7]; 2010: 3.4%[3.1–3.8]).

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