Hospital readmission after perioperative acute myocardial infarction associated with noncardiac surgery

Nathaniel R. Smilowitz, Joshua A. Beckman, Scott E. Sherman, Jeffrey S. Berger

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Acute myocardial infarction (AMI) is a major cardiovascular complication of noncardiac surgery. We aimed to evaluate the frequency, causes, and outcomes of 30-day hospital readmission after perioperative AMI. METHODS: Patients who were diagnosed with AMI during hospitalization for major noncardiac surgery were identified using the 2014 US Nationwide Readmission Database. Rates, causes, and costs of 30-day readmissions after noncardiac surgery with and without perioperative AMI were identified. RESULTS: Among 3 807 357 hospitalizations for major noncardiac surgery, 8085 patients with perioperative AMI were identified. A total of 1135 patients (14.0%) with perioperative AMI died in-hospital during the index admission. Survivors of perioperative AMI were more likely to be readmitted within 30 days than surgical patients without perioperative AMI (19.1% versus 6.5%, P<0.001). The most common indications for 30-day rehospitalization were management of infectious complications (30.0%), cardiovascular complications (25.3%), and bleeding (10.4%). In-hospital mortality during hospital readmission in the first 30 days after perioperative AMI was 11.3%. At 6 months, the risk of death was 17.6% and ≥1 hospital readmission was 36.2%. CONCLUSIONS: Among patients undergoing noncardiac surgery who develop a perioperative MI, ∼1 in 3 suffer from in-hospital death or hospital readmission in the first 30 days after discharge. Strategies to improve outcomes of surgical patients early after perioperative AMI are warranted.

Original languageEnglish (US)
Pages (from-to)2332-2339
Number of pages8
JournalCirculation
Volume137
Issue number22
DOIs
StatePublished - 2018

Keywords

  • Acute coronary syndrome
  • Hospital readmission
  • Myocardial infarction
  • Noncardiac surgery
  • Perioperative
  • Readmission
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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