Percutaneous coronary intervention (PCI) is a commonly performed procedure. However, complications may occur, both during the hospital stay and after discharge, for which the patient may need to be hospitalized again. 

In a single center study of more than 15,000 patients who underwent PCI between 1998 and 2008, the 30-day readmission rate was 9.4%. Patients who were readmitted were at significantly higher risk of one-year mortality (Arch Intern Med. 2012 Jan 23;172(2):112-7). 

In this study, the following factors were found to be associated with an increased risk of readmission:

• Female sex
• Medicare insurance
• Having less than high school education
• Unstable angina
• Cerebrovascular accident or transient ischemic attack
• Moderate to severe renal disease
• Chronic obstructive pulmonary disease
• Peptic ulcer disease
• Metastatic cancer
• Length of stay >3 days 

The factors that increase the risk of re-hospitalization are all non-modifiable. 

There are medicolegal implications to this. 

Readmission rates for all diseases form the quality benchmark for health systems and indicate the quality of treatment. PCI is just one such example. 

This is also a requirement of NABH (National Accreditation Board for Hospitals and Healthcare Providers) Standards for Hospitals as well. The NABH Guide to Accreditation Standards of Hospitals (2015) states, “The organisation shall ensure that the programme is in consonance with good clinical practices. Good clinical practices include monitoring infection rates, re-admission rates, re-intubation rates, etc.” 

The readmission rate should be mentioned in the contract or informed consent signed at the time of admission and in the discharge advice. 

Readmission should be anticipated. Rehospitalization also means increased cost of treatment. If a patient is insured, then he/she could use the Mediclaim or at least a major part of it, for the procedure in the initial admission. 

The treating doctor should explain the chances of death and unexpected complications and the financial implications at the time of admission.

Perhaps, the cost of treatment of complications can be included as part of initial payment as “insurance”, as a fixed charge. For instance, if the entire cost amounts to Rs 2 lakh, then the patient can be asked to pay a sum of Rs. 2.5 lakh. The extra amount would take care of 0-30 day readmission of the patient for complications related to the initial procedure performed.