title: Thirty-day readmission after lower extremity bypass in diabetic patients.
abstract: BACKGROUND
  Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics and is associated with readmission. Thus, we hypothesized that diabetes might be a predictor of 30-d unplanned readmission after LEB.
  
  
  METHODS
  Patients undergoing infrainguinal LEB in the 2011-12 American College of Surgeons National Surgery Quality Improvement Program database were divided into nondiabetics mellitus (NDM), non-insulin-dependent diabetics mellitus (NIDDM), and insulin-dependent diabetic mellitus (IDDM). Univariate and multivariate analyses were used to evaluate the influence of diabetes on 30-d readmission.
  
  
  RESULTS
  A total of 9207 patients (5155 [56%] NDM, 1690 (18%) NIDDM, and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 patients (16%). IDDM had significantly higher crude postoperative complication (43% versus 30% NDM, 36% NIDDM; P < 0.001) and unplanned readmission rates (20% versus 14% NDM, 16% NIDDM; P < 0.001). Concomitant cardiac disease significantly modified the association between diabetes and unplanned readmission. On multivariable analysis, IDDM was an independent predictor of unplanned readmission in the absence of cardiac disease (odds ratio [OR] = 1.23; 95% confidence interval [CI], 1.03-1.47; P = 0.01). However, this association did not remain significant in the presence of cardiac disease (OR = 0.70; 95% CI, 0.48-1.01; P = 0.56). On subgroup analysis of those without cardiac disease, cardiac complications were a significant risk factor for readmission in IDDM (OR = 2.00; 95% CI, 1.12-3.57; P = 0.02) but not NDM (P = 0.31) or NIDDM (P = 0.10).
  
  
  CONCLUSIONS
  Although post-LEB unplanned readmission was more common among diabetics, IDDM was independently associated with unplanned readmission only in those without cardiac disease. This was driven, in part, by increased cardiac complications. Therefore, a more stringent preoperative cardiac workup in this group should be considered before LEB.
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Alireza
authors.initials: A
authors.lastname: Najafian
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Shalini
authors.initials: S
authors.lastname: Selvarajah
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Vascular Surgery, Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Ehlert
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Kristine C
authors.initials: KC
authors.lastname: Orion
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: cabular1@jhmi.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
mesh_terms: D000368:Aged; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Diabetes mellitus; Lower extremity bypass; NSQIP; Outcome research; Unplanned readmission; Vascular surgery