Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery

Annapoorna Mary; Fawaz Mzayek; Leanne L Lefler; Yu Joyce Jiang; Meghan Meadows Taylor

doi:10.1097/NCM.0000000000000718

Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery

Prof Case Manag. 2024 Mar 1. doi: 10.1097/NCM.0000000000000718. Online ahead of print.

Authors

Annapoorna Mary^{1

2

3

4

5}, Fawaz Mzayek^{1

2

3

4

5}, Leanne L Lefler^{1

2

3

4

5}, Yu Joyce Jiang^{1

2

3

4

5}, Meghan Meadows Taylor^{1

2

3

4

5}

Affiliations

¹ Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP).
² Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease.
³ Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease.
⁴ Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields.
⁵ Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches.

PMID: 38421737
DOI: 10.1097/NCM.0000000000000718

Abstract

Purpose of study: Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery.

Primary practice settings: The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital.

Methodology and sample: A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery.

Results: The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001).

Implications for case management practice: Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.