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INTRODUCTION:
Post-operative readmissions to the hospital are under scrutiny as efforts to control health care costs surmount. Starting January 1, 2011, the ACS NSQIP began capturing readmission data from over 300 hospitals within 30 days of major surgical procedures. This study analyzed 30-day hospital readmissions after aorto-iliac (AI) and lower extremity (LE) revascularization in order to further characterize readmissions and to identify modifiable targets for reducing readmission rates.
METHODS:
We performed a retrospective analysis of the large, multicenter, prospectively collected NSQIP dataset from 2011. Readmissions were categorized as planned/unplanned and related/unrelated to the index procedure. The primary endpoint, unplanned readmissions related to the procedure, was calculated for open and endovascular aorto-iliac and lower extremity revascularizations. Multivariable logistic regression was performed to determine independent demographic, preoperative clinical and intraoperative risk factors for unplanned readmissions related to the procedure.
RESULTS:
A total of 8494 patients underwent aorto-iliac and lower extremity revascularization with a thirty-day readmission rate of 16.4% (Table 1). Ninety percent of all readmissions were unplanned and 54% were unplanned and related to the index procedure. Reasons for unplanned readmissions related to the procedure were infection (43.1%), wound complications (16.5%), graft complications (13.6%), cardiac events (3.6%), neurologic events (2.9%), and DVT/PE (2.4%). Procedures were performed in the minority of all readmissions (7.7%) and included vascular intervention (28.7%), amputation (24%), debridement (14%), and incision and drainage (10%). The rate of readmission for all open AI and LE revascularizations (8.4% and 11.4%, respectively) was double the rate for endovascular revascularizations (4.3% and 5.0%, respectively). Multivariate analysis identified several independent risk factors associated with unplanned readmissions related to the procedure: open procedure (OR 1.53, P=0.043), operative time > 260 minutes (OR 1.66, P<=0.002), blood transfusion (OR 1.24, P=0.021), BMI 30-35 (OR 1.56, P<0.001), and preoperative open wound/infection (OR 1.23, P= 0.012). Interestingly, length of hospital stay and age were not independent predictors of unplanned readmissions related to the procedure.
CONCLUSIONS:Aortoiliac and lower extremity revascularization procedures result in readmission of 16.4% of patients; infection alone accounts for one-third of unplanned readmissions related to the index procedures. Readmission occurs more often after open procedures. Preoperative open wound or infection was an independent risk factor for readmission. Interventions focused on wound care management and avoidance of infectious complications may reduce readmission after these procedures.