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Predictors of Length of Stay and Hospital Readmissions Following First-Time Valve Surgery
Niv Ad, Sari D. Holmes, Graciela Pritchard, Linda Halpin.
Inova Heart and Vascular Institute, Falls Church, VA, USA.

OBJECTIVE: Recent financial challenges highlight the importance for accurate prediction of prolonged length of hospital stay (LOS) and hospital readmissions. Our aims were to assess reliability of STS risk prediction for extended LOS and examine whether modifiable factors are associated with LOS and readmission in first-time valve surgery patients.
METHODS: Isolated aortic valve (N=359) or mitral valve (N=302) surgery patients since 2007 were included in analyses (N=661). Multivariate linear regression evaluated modifiable predictors of LOS after adjustment for non-modifiable factors including STS risk for long LOS (>14 days). Logistic regression evaluated modifiable factors associated with readmissions <30 days, with the addition of ICU stay hrs and disposition. Major perioperative morbidity included: perioperative MI, deep sternal wound infection, stroke, prolonged ventilation, pneumonia, reoperation for bleeding, and renal failure.
RESULTS: Mean age was 61.9±13.6 years, mean EF was 58.7%±9.7%, emergent status in 2%, and majority of patients were male (63%) and Caucasian (83%). Mean LOS was 6.0±6.9 days (median [IQR] LOS=4 [3-6] days). Mean STS risk for long LOS was 6.2%±7.8% and mean STS mortality risk was 1.9%±3.3%. Observed long LOS was 7% of patients (O/E ratio=1.1). Addition of modifiable factors to the multivariate model predicting LOS as a continuous variable made a significant impact (r square change=0.23, p<0.001) with independent modifiable predictors including non-fast track patient, major perioperative morbidity, and blood transfusion (TABLE). The only modifiable factor found to predict readmissions <30 days was discharge to home (OR=4.74, p=0.025). Postoperative LOS in days was not predictive of readmissions (OR=1.06, p=0.228), when added to the model.
CONCLUSIONS: This study demonstrated that STS risk prediction for LOS>14 days is reliable in valve patients. However, no valid model to predict exact LOS in days is available. Important modifiable variables associated with LOS should be accounted for especially in elective patients in an attempt to reduce LOS. The association of discharge location with readmissions should be examined further to decrease the rate and cost associated with surgery.

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