Abstract
Introduction:
Pericarditis is a relatively common cause of chest pain and is the most common pericardial syndrome in clinical practice. Pericardiectomy is the treatment of choice for patients with chronic or recurrent pericarditis refractory to medical therapy. However, perioperative morbidity and mortality rates for pericardiectomy remain high. Several factors, such as etiology, duration of disease, patient functional status, and operator/center experience, can impact outcomes.
Objectives:
In this study, we explore the national trends in perioperative complication rates, in-hospital mortality, readmission rates, and impact of center volumes on these endpoints in patients undergoing pericardiectomy.
Methods:
Using the Nationwide Readmissions Database (NRD), we identified patients who underwent isolated pericardiectomy from 2010 to 2018. Year-over-year trends in mortality and readmission rates were assessed using orthogonal polynomial contrasts, with non-linear trends evaluated as needed. Multivariable logistic regression models were constructed to identify independent predictors of mortality and readmission. All analyses accounted for NRD sampling design and were performed using the SAS v. 9.4 with a p < .05 to indicate statistical significance.
Results:
A total of 23,230 hospitalizations for pericardiectomy were identified during the study period. Median age was 59 years and 44% were female. In-hospital mortality was 5.3%, median length of stay was 7 days, and 18% were readmitted within 30 days. While rates were relatively consistent early on, between 2015 and 2018, there was a slight increase in the hospitalizations for pericardiectomy, decrease in in-hospital mortality and an uptick in 30 day all-cause readmission rates. Advanced age, higher comorbidity index, and lower annual facility pericardiectomy volume were independent predictors of in-hospital mortality.
Conclusion:
Isolated pericardiectomy rates have remained largely constant with relatively small changes in in-hospital mortality and 30-day readmission rates over the last decade. Advanced age, facility pericardiectomy volume, and the Elixhauser Comorbidity Index are independent predictors of surgical mortality.