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El impacto de las reinternaciones en la mortalidad alejada de los pacientes operados de cirugía cardíaca.;
Impact of Readmissions on Long-term Mortality of Patients Undergoing Cardiac Surgery

Creators:Korolov, Yevgeniy; Servicio de Recuperación cardiovascular. Instituto cardiovascular de Buenos Aires (ICBA)., Lamelas, Pablo, Espinoza, Juan, Benzadon, Mariano, Vrancic, Mariano, Piccinini, Fernando, Camporrotondo, Mariano, Navia, Daniel, Benzadón, Mariano
2018-01-16

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Descripción

Introducción: Las reinternaciones luego de cirugía cardíaca son un problema relevante para los pacientes y para el sistema de salud en general. Existen pocos datos respecto de la relación entre las reinternaciones después de cirugía cardíaca y el pronóstico evolutivo de los pacientes, ni su impacto en la mortalidad alejada. Objetivo: Analizar la incidencia, factores predictores de las reinternaciones a 30 días luego de cirugía cardíaca y su asociación con la mortalidad alejada. Material y Métodos: Se analizó en forma retrospectiva la base de datos informatizada del servicio de cirugía cardíaca. En el análisis se incluyeron a todos los pacientes sometidos a cirugía cardíaca en forma consecutiva, dados de alta en el período comprendido entre junio del 2010 y mayo del 2013. Se excluyeron a los pacientes operados de trasplante cardíaco. Reinterna� íaco. Reinterna� aco. Reinterna� ción se definió como el reingreso hospitalario no planificado dentro de los 30 días transcurridos desde el egreso hospitalario. Mortalidad alejada fue considerada la muerte de causa cardiovascular o no cardiovascular a partir del día 30 posterior al alta hasta finalizar el seguimiento. Resultados: Se incluyeron 1327 pacientes, de los cuales se reinternaron 184 (13,9%). La mediana de seguimiento fue de 826 días (IQ 581 a 1085 días). Los pacientes que se reinternaron presentaban mayor tasa de comorbilidades como EPOC (6,5% vs. 2,1%; p 0,002) e insuficiencia cardíaca (12% vs. 6%; p 0,0064). También, en este grupo se observó mayor incidencia de las complicaciones posoperatorias de fibrilación auricular (35% vs. 19%; p &lt; 0,0001) y de bajo gasto cardiaco posoperatorio (9,2% vs. 4%; p 0,004). Entre las causas más frecuentes de las reinternaciones se identificaron a las infecciones (no mediastinitis) (25%), arritmias e implante de MCP (15,2%), insuficiencia cardíaca (13%), derrame pleural (6,5%), derrame pericárdico (3,8%), fiebre sin foco establecido (3,26%) y mediastinitis (6%), entre otras. Según el análisis de regresión logística los factores que se asociaban con mayor riesgo de reinternación fueron la cirugía cardíaca no CRM (IC 95% 1,55�3,37; p&lt;0,0001), antecedentes de enfermedad respiratoria (IC 95% 1,32�6,6; p 0,0084), fibrilación auricular (OR 1,99; IC 95% 1,34�2,94; p 0,0005) e IMC (OR 1,046; IC 95% 1,008�1,085; p 0,017). En cuanto al punto final, las reinternaciones se asociaron en forma significativa con aumento en la mortalidad a 1 y 3 años: 8,7% vs. 2,3%; p&lt;0,0001 y 13,6% vs. 4,2%, p&lt;0,0001, respectivamente. Conclusiónes: La reinternación a 30 días luego de cirugía cardíaca se asocia en forma significativa con mayor mortalidad alejada de los pacientes operados. La implementación de las medidas asistenciales adecuadas podría reducir la probabilidad de las reinternaciones, y por ende, mejorar el pronóstico de este grupo de pacientes

Background: Readmissions after cardiac surgery are a relevant issue for patients and the health care system in general. There are limited data about the relationship between readmissions after cardiac surgery and patient prognosis, or their impact on long�term mortality. Objective: The aim of this study was to analyze the incidence and the predictive factors of 30�day readmissions after cardiac surgery and their association with a long�term mortality. Methods: The Division of Cardiac Surgery computerized database was retrospectively analyzed. The analysis included all consecutive patients undergoing cardiac surgery, discharged during the period between June 2010 and May 2013. Patients undergoing heart transplantation were excluded from the study. Readmission was defined as unplanned hospital admission within 30 days following discharge. Cardiovascular or non�cardiovascular death 30 days after discharge and until the end of follow�up period was considered as long�term mortality. Results: A total of 1,327 patients were included in the study and 184 (13.9%) were readmitted to hospital. Median follow�up was 826 days (IQR 581 to 1,085 days). Readmitted patients presented higher rate of comorbidities, as chronic obstructive pulmonary disease (6.5% vs. 2.1%; p=0.002) and heart failure (12% vs. 6%; p=0.0064). Also, in this group there was greater incidence of postoperative complications, as atrial fibrillation (35% vs. 19%; p&lt;0.0001) and low cardiac output (9.2% vs. 4%; p=0.004). Infections (not mediastinitis) (25%), arrhythmias and permanent pacemaker implantation (15.2%), heart failure (13%), pleural effusion (6.5%), pericardial effusion (3.8%), fever of unknown origin (3.26%) and mediastinitis (6%), among others, were the most frequent causes of readmission. Logistic regression analysis showed that the factors associated with greater risk of readmission were cardiac surgery not involving coronary artery bypass grafting (OR 2.29, 95 % CI 1.55�3.37; p &lt;0.0001), history of pulmonary disease (OR 2.95, 95% CI 1.32�6.6; p=0.0084), atrial fibrillation (OR 1.99; 95% CI 1.34� 2.94; p=0.0005) and body mass index (OR 1.046; 95% CI 1.008�1.085; p=0.017). Considering the primary endpoint, readmis� sions were significantly associated with increased mortality at 1 and 3 years: 8.7% vs. 2.3%; p &lt;0.0001 and 13.6% vs. 4.2%; p&lt;0.0001, respectively. Conclusions: Readmission within 30 days after cardiac surgery is significantly associated with long�term mortality. The implementation of adequate care measures could reduce the probability of readmissions and, hence, improve the prognosis of this group of patients.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 85, No 4 (2017); 340-345, Argentine Journal of Cardiology; Vol 85, No 4 (2017); 340-345

Citación

Korolov, Yevgeniy; Servicio de Recuperación cardiovascular. Instituto cardiovascular de Buenos Aires (ICBA). et al., “El impacto de las reinternaciones en la mortalidad alejada de los pacientes operados de cirugía cardíaca.,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/9256.

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Materia

Autor

Korolov, Yevgeniy; Servicio de Recuperación cardiovascular. Instituto cardiovascular de Buenos Aires (ICBA).
Lamelas, Pablo
Espinoza, Juan
Benzadon, Mariano
Vrancic, Mariano
Piccinini, Fernando
Camporrotondo, Mariano
Navia, Daniel
Benzadón, Mariano

Fuente

Revista Argentina de Cardiología; Vol 85, No 4 (2017); 340-345
Argentine Journal of Cardiology; Vol 85, No 4 (2017); 340-345

Editor

Sociedad Argentina de Cardiología

Fecha

2018-01-16

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

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spa
eng

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info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion