Clinical Investigation
Pediatrics
Hospital readmissions in children with congenital heart disease: A population-based study

https://doi.org/10.1016/j.ahj.2007.11.003Get rights and content

Background

Little is known about the factors that predispose children with congenital heart disease (CHD) to readmission soon after hospital discharge. We sought to determine rates and risk factors for hospital readmission within 1 month among children with CHD.

Methods

Data were obtained from administrative databases that record all hospitalizations within the province of Quebec. We included children 0 to 17 years with CHD who were hospitalized with a cardiac diagnosis (an “index hospitalization”) between 1990 and 2005. Cox proportional hazards analysis was used to identify predictors of readmission.

Results

Among 3675 hospitalizations, there were 518 readmissions (15%) within 31 days. Median time to readmission was 12 days (interquartile range 5-19 days). Readmissions occurred in the same hospital as the index hospitalization 86% of the time. The most common diagnoses at readmission were cardiac (59%) and respiratory illnesses (12%). Independent predictors of readmission were severe CHD lesion, younger age, Friday or Saturday discharge, having an emergency department visit within the preceding 6 months, length of index hospitalization >14 days, and multiple (≥4) diagnoses (either cardiac diagnoses or comorbid conditions). Having an invasive procedure during the index hospitalization reduced the likelihood of readmission.

Conclusions

Readmission occurred after 1 in 7 hospitalizations. Infants and patients with severe CHD lesions were among those more likely to be readmitted. The risk of readmission may be reduced by avoiding hospital discharge at the beginning of a weekend. Further studies are needed to determine if targeted interventions will reduce readmission rates in high-risk patients.

Section snippets

Setting and data sources

This is a population-based study using administrative data from the province of Quebec, Canada, where universal access to health care is provided. A unique health care number is assigned at birth and is systematically linked to all health-related services. The database of the Régie de l'Assurance Maladie du Québec records physician claims, and the hospital discharge database (Med-Echo) records information related to inpatient care. Together, these databases contain demographic information in

Results

There were 4085 hospitalizations that met inclusion criteria over the 15-year period. Of these, hospitalizations were excluded if they were for a day procedure or <1 day in duration (n = 355) or because of death during the index hospitalization (n = 55). The remaining 3675 hospitalizations (among 3675 children) form the study population for analysis, of which 1768 children (48%) were female and 1451 (39%) had severe CHD.

After the 3675 hospitalizations, there were 180 readmissions (5%) within 7

Discussion

In a publicly funded health care system with universal access to care, we found that hospital readmission within 1 month was common, occurring in approximately 1 in 9 children and 1 in 5 infants. The most common problems prompting readmission were cardiac or respiratory illnesses, followed by complications. Children with severe CHD lesions were more likely to be readmitted, as were infants, those who had visited an emergency department in the preceding 6 months, had more complex index

References (18)

  • A.S. Mackie et al.

    Health care resource utilization in adults with congenital heart disease

    Am J Cardiol

    (2007)
  • A.S. Mackie et al.

    Risk factors for readmission after neonatal cardiac surgery

    Ann Thorac Surg

    (2004)
  • L.A. Vricella et al.

    Ultra fast track in elective congenital cardiac surgery

    Ann Thorac Surg

    (2000)
  • A.J. Marelli et al.

    Congenital heart disease in the general population: changing prevalence and age distribution

    Circulation

    (2007)
  • P. Moons et al.

    A pilot study of expenditures on, and utilization of resources in, health care in adults with congenital heart disease

    Cardiol Young

    (2001)
  • E.A. Mitchell et al.

    Risk factors for readmission to hospital for asthma in childhood

    Thorax

    (1994)
  • K.A. McCaul et al.

    Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

    Med J Aust

    (2000)
  • S. Liu et al.

    Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada

    Can J Public Health

    (2000)
  • Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, 9th Revision

    (1977)
There are more references available in the full text version of this article.

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This work has been funded by grant G-02-MA-1137 from the Heart and Stroke Foundation of Canada and grant 6498 from the Fonds de la Recherche en Santé du Québec, Montreal, Quebec, Canada. Dr Mackie is a scientist funded by the Fonds de la Recherche en Santé du Québec, and Dr Rahme is funded by the Canadian Institutes of Health Research. Dr Pilote is a senior scientist funded by the Fonds de la Recherche en Santé du Québec and the William Dawson Professor of Medicine at McGill University. Dr Marelli was funded by the Heart and Stroke Foundation of Canada.

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