Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures.
BACKGROUND
Lowering the 30-d re-admission rate after vascular surgery offers the potential to improve healthcare quality. This study evaluated re-admission associated with infections after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).


METHODS
Patients admitted for elective LE procedures for PAD were selected from the Cerner Health Facts®database. Chi-square analysis evaluated the characteristics of the index admission associated with infection at 30-d re-admission. Multivariable logistic models were created to examine the association of patient and procedural characteristics with infections at re-admission. The microbiology data available at the time of re-admission were evaluated also.


RESULTS
A total of 7,089 patients underwent elective LE procedures, of whom 770 (10.9%) were re-admitted within 30 d. A total of 289 (37.5%) had a diagnosis of infection during the re-admission. These infections included surgical site (14.8%), cellulitis (13.6%), sepsis (8.8%), urinary tract (4.9%), and pneumonia (4.9%). Index stay factors associated with infection at re-admission were fluid and electrolyte disorders, kidney disease, diabetes, previous infection, and chronic anemia. Laboratory results associated with an infection during re-admission were post-operative hemoglobin <8 g/dL, blood urea nitrogen >20 mg/dL, platelet counts >400 × 103/mcL, glucose >180 mg/dL, and white blood cell count >11.0 × 103/mcL. Adjusted models demonstrated longer stay, chronic anemia, previous infection, treatment at a teaching hospital, and hemoglobin <8 g/dL to be risk factors for re-admission with infection. Infective organisms isolated during the re-admission stay included Staphylococcus, Enterococcus, Escherichia, Pseudomonas, Proteus, and Klebsiella.


CONCLUSIONS
Infectious complications were associated with more than one-third of all re-admissions after LE procedures. Predictors of re-admission within 30 d with an infectious complication were longer stay, greater co-morbidity burden, hospitalization in teaching facilities, hemoglobin <8 g/dL, and an infection during the index stay. Microbiology examination at re-admission demonstrated gram-negative bacteria in more than 40% of infections. Further evaluation of high-risk vascular patients prior to discharge and consideration of antibiotic administration for gram-negative organisms at the time of re-admission may improve outcomes.
1 Division of Vascular Surgery, University of Missouri School of Medicine , Columbia, Missouri.
Joseph C
JC
Melvin
2 Department of Family and Community Medicine, University of Missouri School of Medicine , Columbia, Missouri.
Jamie B
JB
Smith
2 Department of Family and Community Medicine, University of Missouri School of Medicine , Columbia, Missouri.
Robin L
RL
Kruse
1 Division of Vascular Surgery, University of Missouri School of Medicine , Columbia, Missouri.
Todd R
TR
Vogel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014656:Vascular Surgical Procedures; D055815:Young Adult