title: Predictors of hospital readmissions after lower extremity amputations in Canada.
abstract: OBJECTIVE
  To describe the factors associated with early (≤30 days) and late (31-365 days) hospital readmissions after lower extremity amputations in Canada.
  
  
  METHODS
  A retrospective cohort study was carried out for all Canadian adults who underwent elective lower extremity amputations in the years 2006 to 2008 for nontraumatic indications. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada, with the exception of the Province of Quebec.
  
  
  RESULTS
  During the study period, 3823 patients underwent lower limb amputations (major amputations = 95%) and 2116 were readmitted at least once (55.4%). Of those patients, 1112 (29.1%) were readmitted within 30 days (mean = 5.0 ± 8.3 days after discharge) and 1004 (26.3%) were readmitted between 31 and 365 days (mean = 151.4 ± 95.9 days after discharge). Stump complications accounted for 13% and 10% of early and late readmissions, respectively. Stump revision surgery was performed in 301 readmitted patients (7.9%). Predictors of early readmission included amputation by a vascular surgeon (odds ratio, 1.6; 95% confidence interval, 1.3-1.9), female sex (odds ratio, 1.2; 95% confidence interval, 1.1-1.5), and a short (<7 day) admission (odds ratio, 1.7; 95% confidence interval, 1.4-2.1). Predictors of late readmission included a longer (≥7 days) admission (odds ratio, 1.5; 95% confidence interval, 1.2-1.8), discharge to a long-term care facility (odds ratio, 3.3; 95% confidence interval, 2.7-3.9), and home discharge with community support (odds ratio, 2.3; 95% confidence interval, 1.8-2.9).
  
  
  CONCLUSIONS
  Half of patients who underwent lower extremity amputations were readmitted to the hospital within 1 year. Markers of patient dependence (long hospitalization, discharge to long-term care facility) predict late readmission.
authors.affiliation: Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kayssi
authors.affiliation: Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: de Mestral
authors.affiliation: Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
authors.affiliation: Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: graham.roche-nagle@uhn.ca.
authors.forename: Graham
authors.initials: G
authors.lastname: Roche-Nagle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects*; D002170:Canada; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome