%0 Journal Article
%T Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery
%A Jeremiah R. Brown
%A R. Clive Landis
%A Kristine Chaisson
%A Cathy S. Ross
%A Lawrence J. Dacey
%A Richard A. Boss Jr.
%A Robert E. Helm
%A Susan R. Horton
%A Patricia Hofmaster
%A Cheryl Jones
%A Helen Desaulniers
%A Benjamin M. Westbrook
%A Dennis Duquette
%A Kelly LeBlond
%A Reed D. Quinn
%A Patrick C. Magnus
%A David J. Malenka
%A Anthony W. DiScipio
%J International Journal of Inflammation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/781024
%X Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient¡¯s baseline inflammatory state measured by crude white blood cell (WBC) counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4¨C16). Patients with elevated WBC count at baseline (10,000¨C12,000 and >12,000£¿mm3) had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%¨C12%, ). Adjusted odds ratios were 1.42 (0.86, 2.34) for WBC counts 10,000¨C12,000 and 1.81 (1.03, 3.17) for WBC count£¿>£¿12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient¡¯s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery. 1. Introduction Approximately one in every five hospitalized patients is readmitted within 30 days [1]. Currently, two-thirds of US hospitals have reimbursement penalties for higher than expected 30-day readmission rates from the Center for Medicaid and Medicare Services [2, 3]. It is expected that similar penalties will be extended to other procedures and diagnoses including cardiac surgery. In preparation for the expansion of the penalty system in the USA and to improve prediction of patients at high risk of postdischarge complications leading to readmissions or premature death, risk factors must be identified early in the hospital course to align the best possible quality and continuity of care. Currently, a validated risk model for predicting readmissions after cardiac surgery is not available and few risk factors for readmission are known. Recent evidence from California reported an association between infection and higher rates of 30-day readmission after cardiac surgery [4]. However, identification of infection after discharge without routine monitoring of a postcardiac surgical patient is problematic. What is needed is for clinical care teams to
%U http://www.hindawi.com/journals/iji/2013/781024/