Why Bypass Patients Return to the Hospital

Infections are leading cause of readmissions

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, Aug. 12, 2003 (HealthDayNews) -- If you've just had coronary bypass surgery, there's a one-in-12 chance you'll be back in the hospital within 30 days.

And the leading cause of readmission is hospital-acquired infection, a new study finds.

Doctors have long been aware of the one-in-12 statistic. But the infection finding is new and important because knowing the cause of readmission can lead to ways of preventing it.

So says study leader Edward L. Hannan, chairman of the department of health policy, management and behavior at the University at Albany, State University of New York.

"Things can be done to control infections," Hannan says. "It's possible that a patient has a minor infection, and care should be taken to treat it in the hospital before discharge."

The study, which looked at the records of all 16,325 persons who had bypass surgery in New York state in 1999, found 2,111 were back in the hospital within a month, says the report in the Aug. 13 issue of the Journal of the American Medical Association.

Of those readmissions, 28 percent were caused by hospital-acquired infections, the study found. The second leading cause was heart failure, and again, something can be done about that, Hannan says.

It's standard practice that all bypass patients be given beta blocker drugs upon discharge to help prevent heart failure. But doctors don't always follow that recommendation, he says. The study results call attention to the value of following that advice, Hannan says.

To some extent, the risks cited in the study represent medical advances, says Dr. Irving L. Kron, chief of surgery at the University of Virginia and a member of the American Heart association's surgery council.

Patients who suffer infections or have heart failure after surgery tend to be those who were seriously ill before the operation, Kron says.

"These are groups of patients who we used to say were inoperable but we now operate on," he says. "The sicker you are before surgery, the likelier you are to have a higher infection rate."

But the report is "very, very important," Kron says, because almost all other previous studies used a different measure of bypass surgery effectiveness -- mortality rate.

"What we wanted to look at is whether there are other important adverse outcomes," Hannan says.

The study also looked at which types of doctors and hospitals were associated with a high rate of hospital readmissions. Predictably, it found that patients treated by surgeons who had done fewer than 100 bypasses or were in hospitals with the highest mortality rate were most likely to return to the hospital soon after surgery.

More information

A guide to bypass surgery is offered by the American Heart Association. To learn more about hospital acquired infections, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Edward L. Hannan, Ph.D., chairman, department of health policy, management and behavior, University at Albany, State University of New York; Irving L. Kron, M.D., chief, surgery, University of Virginia, Charlottesville; Aug. 13, 2003, Journal of the American Medical Association

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