Thirty-day readmissions among patients with cardiogenic shock who underwent extracorporeal membrane oxygenation support in the United States: Insights from the nationwide readmissions database

Abstract

Background

There is a paucity of data on readmission rates and predictors of readmissions in cardiogenic shock patients after contemporary Extracorporeal Membrane Oxygenation (ECMO) use.

Methods

Using the Nationwide Readmission Database, we included adult patients (≥18 years old) hospitalized between January to November 2016–2018 for cardiogenic shock requiring ECMO support. Thirty-day readmission rates, associated variables, and predictors of readmission were assessed.

Results

A total of 10,723 patients underwent ECMO for cardiogenic shock. After excluding patients who died ( n = 5602; 52%) and who underwent LVAD or OHT during index admission ( n = 892; 8%), 4229 patients discharged alive were included. Of those, 694 (16.4%) were readmitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR = 1.77; 95% CI 1.32–2.37), chronic liver disease (OR = 1.35; 95% CI 1.03–1.77), and prolonged LOS (≥30 days; OR = 1.38; 95% CI 1.05–1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50–0.95) and short-term hospital post-discharge care (OR = 0.53; 95% CI 0.28–0.99) conferred a lower risk. Sepsis, followed by congestive heart failure, was the most common readmission diagnoses.

Conclusions

Patients with CS requiring ECMO support have high mortality and high 30-day readmission rates, with sepsis being the leading cause of readmissions followed by heart failure.