Aleksander Zywot, Christine S.M. Lau, Nina Glass, Stephanie Bonne, Franchesca Hwang, Koren Goodman, Anne Mosenthal, Subroto Paul

Coronary artery bypass graft (CABG) surgery is associated with all-cause readmission rates of approximately 15%. In attempts to reduce readmission rates, the Hospital Readmission Reduction Program expanded to include CABG surgeries in 2015. The aim of this study was therefore to develop a predictive readmission scale that would identify patients at higher risk of readmission after CABG using commonly available administrative data. Data on 126,519 patients from California and New York (derivation cohort) and 94,318 patients from Florida and Washington (validation cohort) were abstracted from the State Inpatient Database (2006-2011). The readmission after CABG scale was developed to predict 30-day readmission risk and was validated against a separate cohort. Thirty-day CABG readmission rates were 23% in the derivation cohort and 21% in the validation cohort. Predictive factors included: older age, female gender (odds ratio (OR) 1.34), ethnicity (African American (OR 1.13), and Medicare or Medicaid insurance, as well as comorbidities including renal failure (OR 1.56) and congestive heart failure (OR 2.82). These were independently predictive of increased readmission rates (p<0.01). The readmission scale was then created with these preoperative factors. When applied to the validation cohort, it explained 98% of the readmission variability. The readmission after CABG scale reliably predicts a patient's 30-day CABG readmission risk. By identifying patients at high-risk for readmission prior to their procedure, risk reduction strategies can be implemented to reduce readmissions and healthcare expenditures.