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Ann Thorac Surg 2004;78:1978
© 2004 The Society of Thoracic Surgeons

INVITED COMMENTARY

Wan Li, MD

FuWai Cardiovascular Hospital, No 167 Beilishi Ave, Beijing, China

wlzh7580{at}yahoo.com.cn

Almost all aspects of medical practice, including congenital cardiac surgery, have felt the changes in healthcare delivery. Repeat hospitalization of children who have endured such operation burdens the health care resource as well as upset the family. The surgical team should be responsible for reducing the incidence of rehospitalization by appropriately planning preoperative, intraoperative, and postoperative strategies, although that is difficult in complex situations.

Much research has been done to reduce death among neonates and infants after cardiac surgery. But little has focused on reducing readmission. In this paper the authors make many useful observations. They applied conditional logistic regression for matched case-control designs to describe the risk factors for hospital readmission within 30 days of discharge after the arterial switch operation and Norwood procedure in newborn infants. Several findings were revealed by using univariate and multivariate analyses, and some conclusions were made using these data: (1) hospital readmission after the Norwood procedure was more likely in patients who did not establish full oral intake earlier than 2 days before discharge or had significant residual hemodynamic problems; (2) an intensive care unit stay longer than 7 days or the presence of residual hemodynamic problems predicted readmission in infants after the arterial switch operation; and (3) low zip code median family income predicted a lower likelihood of readmission when all readmitted patients were analyzed together. The authors also presented some reasonable explanation for the differences between the Norwood procedure and arterial switch operation. Based on these data, the authors suggested that some hospital readmissions could be prevented.

Further research is needed to confirm the results of this single-center investigation. More work should be done to discover the optimal management to balance the risk of readmission against financial and psychosocial costs.


Related Article

Risk Factors for Readmission After Neonatal Cardiac Surgery
Andrew S. Mackie, Kimberlee Gauvreau, Jane W. Newburger, John E. Mayer, and Lars C. Erickson
Ann. Thorac. Surg. 2004 78: 1972-1978. [Abstract] [Full Text] [PDF]




This Article
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