Rehospitalization to primary versus different facilities following abdominal aortic aneurysm repair.
OBJECTIVE
Reducing readmissions represents a unique opportunity to improve care and reduce health care costs and is the focus of major payers. A large number of surgical patients are readmitted to hospitals other than where the primary surgery was performed, resulting in clinical decisions that do not incorporate the primary surgeon and potentially alter outcomes. This study characterizes readmission to primary vs different hospitals after abdominal aortic aneurysm (AAA) repair and examines the implications with regard to mortality and cost.


METHODS
Patients who underwent open or endovascular aneurysm repair for AAA were identified from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse, a random 5% national sample of Medicare beneficiaries from 2005 to 2009. Outcomes for patients who underwent AAA repair and were readmitted within 30 days of initial discharge were compared based on readmission location (primary vs different hospital).


RESULTS
A total of 885 patients underwent AAA repair and were readmitted within 30 days. Of these, 626 (70.7%) returned to the primary facility, and 259 (29.3%) returned to a different facility. Greater distance from patient residence to the primary hospital was the strongest predictor of readmission to a different facility. Patients living 50 to 100 miles from the primary hospital were more likely to be readmitted to a different hospital compared with patients living <10 miles away (odds ratio, 8.50; P < .001). Patients with diagnoses directly related to the surgery (eg, wound infection) were more likely to be readmitted to the primary hospital, whereas medical diagnoses (eg, pneumonia and congestive heart failure) were more likely to be treated at a different hospital. There was no statistically significant difference in mortality between patients readmitted to a different or the primary hospital. Median total 30-day payments were significantly lower at different vs primary hospitals (primary, $11,978 vs different, $11,168; P = .04).


CONCLUSIONS
Readmission to a different facility after AAA repair is common and occurs more frequently than for the overall Medicare population. Patients travelling a greater distance for AAA repair are more likely to return to different vs the primary hospital when further care is required. For AAA repair, quality healthcare may be achieved at marginally lower cost and with greater patient convenience for selected readmissions at hospitals other than where the initial procedure was performed.
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Richard S
RS
Saunders
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Sara
S
Fernandes-Taylor
Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisc; Geriatric Research Education and Clinical Center (GRECC), William S Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisc.
Amy J H
AJ
Kind
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Travis L
TL
Engelbert
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Caprice C
CC
Greenberg
Departments of Population Health Sciences, Family Medicine and Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Maureen A
MA
Smith
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Jon S
JS
Matsumura
Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc. Electronic address: kent@surgery.wisc.edu.
K Craig
KC
Kent
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States