title: Causes and implications of readmission after abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair.
  
  
  BACKGROUND
  Centers for Medicare & Medicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed.
  
  
  METHODS
  We analyzed elective AAA repairs over a 2-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries.
  
  
  RESULTS
  A total of 2481 patients underwent AAA repair--1502 endovascular aneurysm repair (EVAR) and 979 open aneurysm repair. Thirty-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). Although wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed-eg, bowel obstruction was common after open repair, and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors, including serious complications leading to prolonged length of stay and discharge destination other than home, had a profound influence on the probability of readmission. The 1-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (P < 0.001).
  
  
  CONCLUSIONS
  Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.
authors.affiliation: Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, WI 53792-7375, USA.
authors.forename: David Yu
authors.initials: DY
authors.lastname: Greenblatt
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.forename: Amy J H
authors.initials: AJ
authors.lastname: Kind
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Havlena
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Mell
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Nelson
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000379:methods