title: Predictors and consequences of unplanned hospital readmission within 30 days of carotid endarterectomy.
abstract: OBJECTIVE
  In the United States, vascular surgeons frequently perform carotid endarterectomy (CEA). Given the resource burden of unplanned readmission (URA), we sought to identify the predictors and consequences of URA after this common vascular surgery procedure to identify potential points of intervention.
  
  
  METHODS
  Using a prospective single-institution database, we retrospectively identified consecutive patients undergoing CEA (2001-2011). Demographic and perioperative factors were prospectively collected. The primary end point was 30-day postdischarge URA after CEA. The secondary end point was 1-year survival. We performed a univariable analysis for URA followed by a multivariable Cox model. A Kaplan-Meier analysis was performed for 1-year survival.
  
  
  RESULTS
  During the study period, 840 patients underwent 897 CEAs. The 30-day postdischarge overall readmission rate and URA rate were 8.6% and 6.5%, respectively. Most URA patients (n = 42; 73.4%) were readmitted for a CEA-related reason (headache, cardiac, hypertension, surgical site infection, bleeding/hematoma, stroke/transient ischemic attack, dysphagia, or hyperperfusion syndrome). Seventeen patients (29.3%) had more than one reason for URA. Median time to URA was 4 days (interquartile range, 1-9 days). Postoperative length of stay, indication for CEA, and discharge destination were not associated with URA. In multivariable analysis, in-hospital occurrence of congestive heart failure (hazard ratio [HR], 15.1; 95% confidence interval [CI], 4.7-48.8; P < .001), stroke (HR, 5.0; 95% CI, 1.8-14.0; P < .001), bleeding/hematoma (HR, 3.1; 95% CI, 1.4-6.9; P = .003), and prior coronary artery bypass grafting (HR, 2.0; 95% CI, 1.2-3.5; P = .01) were significantly associated with URA. Patients in the URA group also had decreased survival during 1 year (91% vs 96%; P = .01, log-rank).
  
  
  CONCLUSIONS
  The 30-day URA rate after CEA is low (6.5%). Prior coronary artery bypass grafting and in-hospital postoperative occurrence of stroke, bleeding/hematoma, and congestive heart failure identify those at increased risk of URA, and URA signals increased long-term risk of postoperative mortality.
authors.affiliation: Division of Vascular Surgery, Northwestern Memorial Hospital, Chicago, Ill.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Ho
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Arin L
authors.initials: AL
authors.lastname: Madenci
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Semel
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
authors.forename: James T
authors.initials: JT
authors.lastname: McPhee
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: C Keith
authors.initials: CK
authors.lastname: Ozaki
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: mbelkin@partners.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications; D006406:Hematoma / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications