title: Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality.
abstract: The significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.
  
  
  
  This was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow-up of 381 days (interquartile range [IQR], 115-718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33-190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan-Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5-6.5; P=0.002).
  
  
  
  Most readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.
authors.affiliation: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Reed
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Pejman
authors.initials: P
authors.lastname: Raeisi-Giglou
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Rami
authors.initials: R
authors.lastname: Kafa
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Umair
authors.initials: U
authors.lastname: Malik
authors.affiliation: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Negar
authors.initials: N
authors.lastname: Salehi
authors.affiliation: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH shishem@ccf.org.
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017130:Angioplasty / Q000379:methods; D017073:Atherectomy / Q000379:methods; D015897:Comorbidity; D004691:Endarterectomy / Q000706:statistics & numerical data; D057510:Endovascular Procedures; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000601:surgery*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D015607:Stents; D014945:Wound Healing
keywords: critical limb ischemia; major adverse limb events; mortality; peripheral artery disease; readmission; wound healing