title: Reasons for readmission after carotid endarterectomy.
abstract: OBJECTIVE
  With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).
  
  
  METHODS
  Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients. The primary outcome variable was 30-day unplanned readmission. Multiple logistic regression was used, and we controlled for preoperative demographic variables, comorbidities and clinical characteristics, and postoperative medical and surgical complications.
  
  
  RESULTS
  Patients with CEA had a 6.0% unplanned readmission rate. The most common comorbidities in the readmitted patients included hypertension, diabetes, and bleeding disorder. Risk-adjusted multiple regression indicated that preoperative bleeding disorder (odds ratio [OR] 1.62), diabetes (OR 1.46), history of a cerebrovascular accident/stroke (OR 1.46), and increasing age (OR 1.01) were statistically significant predictors for readmission. Postoperatively, surgical-site infection (OR 21.90), myocardial infarction (OR 10.35), sepsis/septic shock (OR 7.79), cerebrovascular accident/stroke (OR 6.58), pneumonia (OR 4.37), and urinary tract infection (OR 3.21) were associated with a greater rate of readmission.
  
  
  CONCLUSIONS
  Readmission after CEA occurs at a comparatively high rate. Preoperative bleeding disorders, diabetes, cerebrovascular accidents, and age and postoperative surgical-site infection, myocardial infarction, sepsis/septic shock, pneumonia, and cerebrovascular accident were associated with readmission. These findings may help guide the surgical management of patients and prevent costly readmissions.
authors: Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Aksharananda
authors: A
authors: Rambachan
authors: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Timothy R
authors: TR
authors: Smith
authors: Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Sujata
authors: S
authors: Saha
authors: Division of Surgery-Vascular, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Mark K
authors: MK
authors: Eskandari
authors: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Bernard R
authors: BR
authors: Bendok
authors: Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: jokim@nmh.org.
authors: John Y S
authors: JY
authors: Kim
mesh_terms: D000368:Aged; D019985:Benchmarking; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D058996:Quality Improvement; D020379:Risk Adjustment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Carotid endarterectomy; Health policy; Hospital readmissions; Neurosurgery; Vascular surgery