Deo et al developed a model for predicting the risk of 30-day readmission for a patient undergoing a coronary artery bypass graft (CABG) procedure. These can help to identify a patient who may benefit from more aggressive management. The authors are from University Hospitals Cleveland, Harrington Heart and Vascular Institute, Queen Alia Medical Center (Jordan), Case Western Reserve University, Dow University of Health Science (Pakistan), Massachusetts general Hospital, and Brown University.
Patient selection: CABG procedure
Outcome: 30-day readmission
Parameters:
(1) sex
(2) history of stroke
(3) prior permanent pacemaker (PPM)
(4) congestive heart failure
(5) atrial fibrillation
(6) end-stage renal disease (ESRD)
(7) renal disease (RD)
(8) peripheral vascular disease
(9) liver disease
(10) COPD
(11) diabetes mellitus
(12) obesity
(13) anemia
(14) weight loss
(15) insurance
(16) old age (> 80 years of age)
(17) acute renal failure
(18) infection
(19) hospital length of stay for index hospitalization in days
Parameter |
Finding |
Points |
sex |
male |
0 |
|
female |
42.3 |
history of stroke |
no |
0 |
|
yes |
23.5 |
prior PPM |
no |
0 |
|
yes |
69.2 |
congestive heart failure |
no |
0 |
|
yes |
41 |
atrial fibrillation |
no |
0 |
|
yes |
33.8 |
end-stage renal disease |
no |
0 |
|
yes |
100 |
RD |
no |
0 |
|
yes |
40.2 |
peripheral vascular disease |
no |
0 |
|
yes |
24.4 |
liver disease |
no |
0 |
|
yes |
51.3 |
COPD |
no |
0 |
|
yes |
35.9 |
diabetes mellitus |
no |
0 |
|
yes |
23.1 |
obesity |
no |
0 |
|
yes |
15.4 |
anemia |
no |
0 |
|
yes |
24.8 |
weight loss |
no |
0 |
|
yes |
53.8 |
insurance |
private |
0 |
|
Medicare |
54.3 |
|
Medicaid |
81.2 |
|
other |
38.5 |
age in years |
<= 80 years |
0 |
|
> 80 years |
42.7 |
acute renal failure |
no |
0 |
|
yes |
30.3 |
infection |
no |
0 |
|
yes |
41.9 |
length of stay |
<= 9 days |
0 |
|
> 9 days |
80.8 |
where:
• End-stage renal disease and renal disease will be treated together in the implementation.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 815.4
• The higher the score the greater the risk of readmission.
• The national average is 12%.
percent readmission =
= (0.00012826 * ((score)^2)) + (0.027158 * (score)) + 5.3002