title: Predictive factors of 30-day unplanned readmission after lower extremity bypass.
abstract: BACKGROUND
  Thirty-day unplanned readmission after lower extremity bypass represents a large cost burden and is a logical target for cost-containment strategies. We undertook this study to evaluate factors associated with unplanned readmission after lower extremity bypass.
  
  
  METHODS
  This is a retrospective analysis from a prospective institutional registry. All lower extremity bypasses for occlusive disease from January 1995 to July 2011 were included. The primary end point was 30-day unplanned readmission. Secondary end points included graft patency and limb salvage.
  
  
  RESULTS
  Of 1543 lower extremity bypasses performed, 84.5% were for critical limb ischemia and 15.5% were patients with intermittent claudication. Twenty-seven patients (1.7%) died in-house and were excluded from further analysis. Of 1516 lower extremity bypasses analyzed, 42 (2.8%) were in patients with a planned readmission within 30 days, and 349 (23.0%), in patients with an unplanned readmission. Most unplanned readmissions were wound related (62.9%). By multivariable analysis, preoperative predictive factors for unplanned readmission were dialysis dependence (odds ratio [OR], 1.73; P = .004), tissue loss indication (OR, 1.62; P = .0004), and history of congestive heart failure (OR, 1.43; P = .03). Postoperative predictors included distal inflow source (OR, 1.38; P = .016), in-hospital wound infection (OR, 8.30; P < .0001), in-hospital graft failure (OR, 3.20; P < .0001), and myocardial infarction (OR, 1.96; P < .04). Neither index length of stay nor discharge disposition independently predicted unplanned readmission. Unplanned readmission was associated with loss of assisted primary patency (hazard ratio, 1.39; 95% confidence interval, 1.08-1.80; P = .01) and long-term limb loss (hazard ratio, 1.68; 95% confidence interval, 1.23-2.29; P = .001).
  
  
  CONCLUSIONS
  Thirty-day unplanned readmission is a frequent occurrence after lower extremity bypass (23.0%). Stratifying patients by risk factors associated with unplanned readmission is essential for quality improvement and equitable resource allocation when disease-specific bundling strategies are being derived.
authors: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA. James.mcphee@bmc.org
authors: James T
authors: JT
authors: McPhee
authors: Neal R
authors: NR
authors: Barshes
authors: Karen J
authors: KJ
authors: Ho
authors: Arin
authors: A
authors: Madenci
authors: C Keith
authors: CK
authors: Ozaki
authors: Louis L
authors: LL
authors: Nguyen
authors: Michael
authors: M
authors: Belkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D058729:Peripheral Arterial Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D014945:Wound Healing; D055815:Young Adult