Hospital Readmission of Patients With Congenital Heart Disease in Canada

Abstract

Background: Risk factors for hospital readmission in children or adults with congenital heart disease (CHD) are poorly understood. We assessed readmission rates among patients with CHD stratified by age, sex, and severity of CHD and identified risk factors associated with hospital readmission.

Methods: A retrospective cohort study was conducted among patients with CHD identified from the Discharge Abstract Database of the Canadian Institute for Health Information from fiscal years 2003-2013. Index hospitalizations were identified and patients followed to identify readmissions. Poisson regression was used to analyze readmission rates by age, sex, and severity of CHD. Logistic regression analysis was performed to identify risk factors associated with readmission within 1 month after discharge.

Results: There were 67,940 index hospitalizations. The readmission rate per 1000 patients with CHD was 48 within 2 weeks, 83 within 1 month, 163 within 3 months, and 351 within 1 year. Patients aged ≥ 65 years had the highest readmission rate at 1 month (12.6%) followed by 40- to 64-year old adults (8.5%), and infants (8.3%). Readmission rates were 2.3-4.1 times higher in patients with complex CHD (P < 0.001) and 1.3-1.8 times higher in patients with moderate CHD (P < 0.001) than in simple patients with CHD. Risk factors for readmission were age ≥ 40 years, age < 1 year, male sex, longer index hospitalization stay, and complex CHD. Increasing Charlson comorbidity score was a risk factor for readmission among adults.

Conclusions: Greater than one third of hospitalized patients with CHD were readmitted within 1 year. Age, sex, and CHD complexity influence readmission risk. Future studies should investigate the reasons for unplanned readmission.