News | May 06, 2011

PCI Complications Seldom Cause Hospital Readmission

Procedure-Related Problems Cited in Fewer Than 1 Percent of Patients

May 6, 2011 — When health quality experts take out a magnifying glass these days, they aren’t just looking at procedural success and complication rates. They’re also counting how many patients are readmitted to the hospital shortly after being sent home. In the case of angioplasty and stenting, that number is very small, according to a study presented yesterday at the Society for Cardiovascular Angiography and Interventions (SCAI) 2011 Scientific Sessions.

Researchers at Geisinger Health System in Danville, Pa., found just 30 out of 4,523 patients who had percutaneous coronary intervention (PCI) – or fewer than 1 percent – were re-hospitalized within 30 days for reasons that could be traced to the PCI procedure itself.

“We found that there are a very, very small number of readmissions caused by PCI complications,” said Gregory Yost, D.O., a resident in internal medicine at Geisinger Medical Center. “One of the reasons may be that we really focus on preventing PCI readmissions. We put a lot of effort into patient education and appropriate follow-up.”

For the study, researchers reviewed the medical records of all 4,523 patients who had PCI, both on a scheduled or emergency basis, between 2007 and 2010. They found that a total of 222 patients (4.9 percent) were readmitted to the hospital within 30 days of going home.

Just under half of the repeat admissions were completely unrelated to the original hospitalization. Another 87 patients (39 percent) were readmitted for a cardiac problem that was unrelated to PCI. Examples of patients in this category include those who experienced chest pain or a heart attack caused by a blockage in an artery different from the one treated with PCI, and those who developed heart failure.

Only 30 patients (13 percent of readmitted patients, or 0.6 percent of all patients) returned to the hospital because of a PCI-related complication. The most common PCI complication was stent thrombosis, or a blockage in the stent caused by blood clots (36 percent of PCI-related complications, or 0.2 percent of all patients). Most other PCI complications involved the puncture site in the groin or wrist where the angioplasty catheter is inserted into the artery.

Another 13 patients (5.8 percent) were readmitted for non-cardiac problems that were somehow related to the original hospitalization. The most common problems were gastrointestinal bleeding, infections and medication reactions.

Yost said that preventing PCI readmissions requires strict adherence to care protocols in the hospital. It also means paying attention to such details as scheduling a follow-up appointment before the patient leaves the hospital and educating patients about restrictions on physical activity and the importance of taking anti-clotting medications.

“They hear this information many times, from doctors, nurses and pharmacists,” he said.

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