The Readmission Event after Vascular Surgery: Causes and Costs.
BACKGROUND
The study evaluates the readmission diagnoses after vascular surgical interventions and the associated hospital costs.


METHODS
Patients readmitted after undergoing carotid artery stenting (CAS), carotid endarterectomy (CEA), infrarenal endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (OAAA), suprainguinal revascularization (SUPRA), or infrainguinal revascularization (INFRA) between January 1, 2008 and October 20, 2013 at a single academic institution were retrospectively identified. Demographic, preoperative, and postoperative event variables were obtained by chart review. The diagnoses and the costs of the readmission event were obtained by chart review and from hospital financial data. Readmission indications were grouped as unrelated or planned readmissions, procedure-specific complications, wound complications, cardiac causes, and other. Univariate analyses of categorical variables were performed with χ2or Fisher exact test where appropriate. Continuous variables were analyzed using the Wilcoxon rank-sum test.


RESULTS
A total of 1,170 patient records were identified. Thirty-day readmission occurred in 112 patients (9.6%). The readmission rate was significantly different between groups: 4.5% in CAS (n = 8/177), 8.5% in CEA (21/246), 5.8% in EVAR (18/312), 11.4% in OAAA (4/35), 15.6% in INFRA (33/212), 13.5% in SUPRA (24/178), and 40% in combined SUPRA and INFRA (4/10) (P < 0.0001). Readmissions were unrelated or planned in 19.6% of patients. Wound complications were the most common readmission diagnoses (36.6%, 41/112).There was a difference in the distribution of readmission indications among procedure groups, with wound complications being predominant in INFRA and SUPRA groups (60.6% and 58.3%, respectively), and cardiac events predominantly in EVAR patients (42%) (P < 0.001). In univariable analysis of predictors of readmission, significant preoperative factors were chronic obstructive pulmonary disease, renal insufficiency, and lower hematocrit. Significant postoperative predictors included any postoperative complication, number of complications, increased length of stay, wound complications, postoperative infections, blood transfusion, and reoperation. The median hospital cost for readmission for wound complications was 29,723 USD (interquartile range 23,841-36,878), and for cardiac complications was 39,784 USD (26,305-46,918). The median cost of readmission for bypass graft occlusion was 33,366 USD (20,530-43,170). The median length of stay also differed depending on the readmission diagnosis and was highest for bypass graft occlusion (8.5 days).


CONCLUSIONS
Readmissions after vascular procedures are associated with high cost and hospital bed utilization. Wound complications continue to be the dominant readmission etiology. The characterization of these costs and risk factors in this study can allow for resource allocation to minimize preventable related readmissions. A significant proportion of readmissions after vascular interventions are planned or unrelated, which should be taken into consideration in metric benchmarking and performance comparisons.
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA. Electronic address: yazan.duwayri@emory.edu.
Yazan
Y
Duwayri
Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Jonathan
J
Goss
Department of Surgery, Emory University School of Medicine, Atlanta, GA.
William
W
Knechtle
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA.
Ravi K
RK
Veeraswamy
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA.
Shipra
S
Arya
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA.
Ravi R
RR
Rajani
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA.
Luke P
LP
Brewster
Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA.
Thomas F
TF
Dodson
Department of Surgery, Emory University School of Medicine, Atlanta, GA.
John F
JF
Sweeney
D017130:Angioplasty / Q000009:adverse effects / Q000191:economics; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics; D002340:Carotid Artery Diseases / Q000191:economics / Q000601:surgery; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000191:economics* / Q000295:instrumentation; D005845:Georgia; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D010359:Patient Readmission / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics* / Q000295:instrumentation