30-Days readmission after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with active cancer: Outcomes and predictors.
Presenter
Juan Del Cid Fratti MD MS, MD MSc, The University of Washington, Peoria, IL
Juan Del Cid Fratti MD MS, MD MSc1, Miguel Salazar, MD2, Sriviji Senthil3, Genaro Velazquez, MD4, Ezequiel Munoz, MD5 and Sudhir Mungee, M.D., FACC, FSCAI5, (1)The University of Washington, Peoria, IL, (2)Cleveland Clinic, Cleveland, OH, (3)OSF St. Francis Medical Center/UICOMP, Peoria, IL, IL, (4)Cook County Health, CHICAGO, IL, (5)University of Illinois College of Medicine at Peoria, Peoria, IL
Keywords: Complications, Coronary and Quality
Background
Hospital readmissions are costly to health-care systems and represent a measure of quality care. We aim to describe the burden, and factors associated with readmissions after PCI with DES in patients with malignancy.
Methods
Retrospective study of the 2017 National Readmission Database (NRD) of patients with cancer readmitted within 30 days after an admission for PCI with DES. We aim to identify 30-day readmission rate, mortality, healthcare related utilization resources and independent predictors of readmission.
Results
8,350 patients with cancer underwent PCI. The 30-day readmission rate was 17%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI and hypertensive heart disease. Readmitted patients were less likely to require mechanical ventilation, IABP, IMPELLA, have private insurance, develop shock, and major bleeding. Readmission was associated with lower in-hospital mortality rate (1.5% vs. 0.1%; P<0.01), require hemodialysis (4.3% vs 6.6%; P<0.01), developd venous thromboembolism (VTE) (1.9% vs 3.2%; P<0.01). The total health care in-hospital burden of readmission was $93 million in total charges and $22 million in total costs. Independent predictors of readmission were female gender, disposition to a short-term hospital or skilled nursing facility, length of stay, inpatient hemodialysis and episodes of VTE.
Conclusions
Readmissions rates for recurrent STEMI and V.Fib in patients with cancer post-DES is high. We identified risk factors that can be targeted to decrease readmission after DES, health care burden, and patient morbidity.
