Risk score for unplanned vascular readmissions.
OBJECTIVE
Vascular surgery patients have high readmission rates, and identification of high-risk groups that may be amenable to targeted interventions is an important strategy for readmission prevention. This study aimed to determine predictors of unplanned readmission and develop a risk score for predicting readmissions after vascular surgery.


METHODS
The National Surgical Quality Improvement Program database for 2011 was queried for major vascular surgical procedures. The primary end point was unplanned 30-day readmissions. The data were randomly split into two-thirds for development and one-third for validation. Multivariable logistic regression was used to create and validate a point score system to predict unplanned readmissions.


RESULTS
Overall, 24,929 patients were included, with 2507 readmissions (10.1%). A point-based scoring system was developed with the use of factors predictive for readmission, including procedure type; discharge destination; race; non-elective presentation; pulmonary, renal, and cardiac comorbidities; diabetes; steroid use; hypoalbuminemia; anemia; venothromboembolism before discharge; graft failure before discharge; and bleeding disorder. The point score stratified patients into 3 groups: low risk (0-3 points) with a readmission rate of 5.4%, moderate risk (4-7 points) with a readmission rate of 8.6%, and high risk (≥ 8 points) with a readmission rate of 16.4%. The model had a C-statistic = 0.67.


CONCLUSIONS
Through the use of patient, operative, and predischarge events, this novel vascular surgery-specific readmission score accurately identified patients at high risk for 30-day unplanned readmission. This model could help direct discharge and home health care resources to patients at high risk, ultimately reducing readmissions and improving efficiency.
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: james_iannuzzi@urmc.rochester.edu.
James C
JC
Iannuzzi
Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY.
Ankur
A
Chandra
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Kristin N
KN
Kelly
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Aaron S
AS
Rickles
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
John R T
JR
Monson
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Fergal J
FJ
Fleming
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects*