title: Differences in readmissions after open repair versus endovascular aneurysm repair.
abstract: OBJECTIVE
  Reintervention rates after repair of abdominal aortic aneurysm (AAA) are higher for endovascular repair (EVAR) than for open repair, mostly due to treatment for endoleaks, whereas open surgical operations for bowel obstruction and abdominal hernias are higher after open repair. However, readmission rates after EVAR or open repair for nonoperative conditions and complications that do not require an intervention are not well documented. We sought to determine reasons for all-cause readmissions within the first year after open repair and EVAR.
  
  
  METHODS
  Patients who underwent elective AAA repair in California during a 6-year period were identified from the Health Care and Utilization Project State Inpatient Database. All patients who had a readmission in California ≤1 year of their index procedure were included for evaluation. Readmission rates and primary and secondary diagnoses associated with each readmission were analyzed and recorded.
  
  
  RESULTS
  From 2003 to 2008, there were 15,736 operations for elective AAA repair, comprising 9356 EVARs (60%) and 6380 open repairs (40%). At 1 year postoperatively, the readmission rate was 52.1% after open repair and 55.4% after EVAR (P=.0003). The three most common principle diagnoses associated with readmission after any type of AAA repair were failure to thrive, cardiac issues, and infection. When stratified by repair type, patients who underwent open repair were more likely to be readmitted with primary diagnoses associated with failure to thrive, cardiac complications, and infection compared with EVAR (all P<.001). Those who underwent EVAR were more likely, however, to be readmitted with primary diagnoses of device-related complications (P=.05), cardiac complications, and infection.
  
  
  CONCLUSIONS
  Total readmission rates within 1 year after elective AAA repair are greater after EVAR than after open repair. Reasons for readmission vary between the two cohorts but are related to the magnitude of open surgery after open repair, device issues after EVAR, and the usual cardiac and infectious complications after either intervention. Systems-based analysis of these causes of readmission can potentially improve patient expectations and care after elective aneurysm repair.
authors.affiliation: Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, Calif.
authors.forename: Kevin
authors.initials: K
authors.lastname: Casey
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Mell
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000453:epidemiology / Q000628:therapy; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D005183:Failure to Thrive / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016016:Proportional Hazards Models; D013997:Time Factors; D016896:Treatment Outcome