title: Medicare inpatient and 90-day postdischarge adverse outcomes in carotid artery surgery.
abstract: BACKGROUND
  Longitudinal, risk-adjusted measurement of outcomes of carotid artery (CA) surgery is necessary for the evaluation of quality performance and for the assessment of strategies of quality improvement.
  
  
  METHODS
  Patients from quality coding hospitals who underwent CA surgery and met procedural and diagnostic coding requirements in the Medicare Inpatient Limited Data Set from 2009 to 2011 were used to design logistic prediction models for the Adverse Outcomes (AOs) of inpatient deaths, 3-sigma prolonged length-of-stay outliers (prLOS) among live discharges, 90-day post-discharge deaths without readmission (PD-90), and 90-day post-discharge readmissions (ReAdm-90).
  
  
  RESULTS
  A total of 653 quality coding hospitals had 54,183 CA surgery cases. There were 122 inpatient deaths (0.23%) and 3,337 (6.2%) prLOS. After discharge, there were 258 patients that were PD-90 and 9,804 patients (18.1 % of live discharges) were readmitted. Among all readmissions, 1,592 (13.3%) were judged to be totally unrelated to the index operation. A total of 495 patients died during readmission to the hospital. The rate of total adverse outcome was 22.6% with all ReAdm-90 cases counted.
  
  
  CONCLUSIONS
  In CA surgery, more AOs occur in the 90 days after discharge than during the inpatient period of care. ReAdm-90 remains the major cause for AOs and represents the greatest opportunity for improvement in the care of CA surgery patients.
authors.affiliation: Michael Pine and Associates, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: dfry@consultmpa.com.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: David
authors.initials: D
authors.lastname: Locke
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: Agnes
authors.initials: A
authors.lastname: Reband
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: Zeke
authors.initials: Z
authors.lastname: Torres
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D020379:Risk Adjustment; D014481:United States