Pediatr Cardiol. 2025 Sep 10. doi: 10.1007/s00246-025-04015-z. Online ahead of print.
ABSTRACT
Patients with acquired and congenital heart disease (CHD) are at higher risk of hospitalization. Despite quality improvement (QI) initiatives, many patients experience readmission soon after discharge. We aimed to identify risk factors for 30-day readmission and hypothesized that direct discharge from the cardiac intensive care unit (CICU) is associated with an increased readmission rate. A single-center retrospective cohort study was performed of patients discharged from the acute care cardiac unit (ACCU) or CICU from January 1, 2022 to June 30, 2024. Pediatric patients with cardiac disease and adults with CHD were included. Patients with a scheduled readmission were excluded. A total of 1,848 hospitalizations were included, and 223 resulted in readmission within 30 days of discharge. In multivariable analysis, no difference was seen in readmission rates between direct CICU discharge or ACCU discharge (36 [11%] vs. 187 [12%], p = 0.7, odds ratio [OR] 1.2 [0.8-1.8]). Readmission risk factors included single ventricle anatomy (odds ratio [OR] 1.7, 95% confidence interval [1.1-2.4]), chromosomal anomaly (1.8 [1.3-2.6]), cardiomyopathy (3.3 [2.1-5.2])), tube feeding (1.6 [1.1-2.5]), and increased length of stay (1.5 [1.2-1.7]). Tracheostomy (1.7 [0.8-3.1]), and prematurity (1.3 [0.8-1.9]) were not associated with increased risk. Weekend discharge (0.6 [0.4-0.9]) and surgical hospitalizations (OR 0.6 [0.4-0.8]) were associated with fewer readmissions. Risk factors for 30-day readmission included underlying medical complexity, single ventricle physiology, and increased length of admission. Discharging patients from the CICU was not associated with an increased readmission rate. The risk factors identified were largely non-modifiable, and future QI initiatives should examine the resources allocated to discharge teaching, care coordination, and follow up in these high-risk populations.
PMID:40931211 | DOI:10.1007/s00246-025-04015-z
