Unplanned readmissions after vascular surgery.
OBJECTIVE
Existing literature on readmission after vascular surgery is limited. The upcoming reduction in Medicare reimbursement for institutions with high readmission rates mandates an accurate understanding of this issue. In this study, we characterize the frequency and causes of 30-day unplanned readmissions after elective vascular surgery.


METHODS
Patients who underwent elective carotid endarterectomy (CEA), endovascular aortic repair (EVAR), open abdominal aortic aneurysm (oAAA) repair, or infrainguinal bypass grafting (BPG) were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2011 database (n = 11,246). Multivariable logistic regression was used to determine variables that contributed to 30-day unplanned readmissions for each surgery type.


RESULTS
The unadjusted unplanned readmission rates after the four vascular procedures ranged from 6.5% for CEA to 15.7% for BPG. In multivariable analyses, patient comorbidities were associated with unplanned readmission after BPG and CEA (P < .05), whereas postoperative complications were more consistently associated with unplanned readmission after EVAR and oAAA repair (P < .05). For all procedures, complications leading to readmission developed more frequently after discharge. Thirty-day mortality was significantly higher in readmitted patients after BPG (1.9% vs 0.3%), EVAR (3.9% vs 0.1%), and CEA (2.2% vs 0.2%; P < .001 for each), but not after oAAA repair.


CONCLUSIONS
Select comorbidities and postoperative complications contribute to unplanned readmissions after vascular surgery. The characteristics of readmitted patients vary with the type of procedure. Interventions designed to mitigate these factors have the potential to reduce unplanned readmissions but likely need to vary with the type of vascular treatment.
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
Prateek K
PK
Gupta
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
Sara
S
Fernandes-Taylor
Department of Surgery, Creighton University, Omaha, Neb.
Bala
B
Ramanan
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc.
Travis L
TL
Engelbert
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisc. Electronic address: kent@surgery.wisc.edu.
K Craig
KC
Kent
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D016009:Chi-Square Distribution; D015897:Comorbidity; D017558:Elective Surgical Procedures; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D058017:Vascular Grafting / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality