title: The Relevance of Readmissions after Common IR Procedures: Readmission Rates and Association with Early Mortality.
abstract: OBJECTIVE
  To determine all-cause readmission rates for 12 IR procedures and association of time to readmission with risk-adjusted 90-day mortality.
  
  
  METHODS
  Patients discharged after 12 inpatient IR procedures at a tertiary-care hospital between June 2008 and May 2013 (N = 4,163) were categorized as no readmission (n = 1,479; 40.5%) or readmission between 0 and 7 (n = 379; 10.4%), 8 and 30 (n = 650; 17.8%), 31 and 60 (n = 378; 10.3%), 61 and 90 (n = 169; 4.6%), or 91 and 180 days (n = 280; 7.7%). Readmission rate ≥ 15% was considered high based on published national readmission rates for procedures. Risk-adjusted 90-day mortality for each interval was calculated for transjugular intrahepatic portosystemic shunt (TIPS), transjugular and percutaneous liver biopsy (TJLB, PLB), ports, inferior vena cava (IVC) filter, lower extremity angioplasty (LEA), arteriovenous fistulagrams, vascular embolization (VE), percutaneous cholecystostomy (PC), percutaneous transhepatic biliary drainage (PTBD), primary urinary drainage, and feeding tube placement. Covariates included age, sex, race, insurance status, and Charlson Comorbidity Index.
  
  
  RESULTS
  All procedures had high 30-day readmission rates (15%-50.5%). Readmissions were highest for ports (50.5%), TJLB (43.4%), PTBD (38.5%), PC (31.9%), and TIPS (31.3%). Readmissions occurred most frequently 8-30 days after discharge for all procedures except VE (31-60 d; 10.6%), PC (31-60 d; 23.4%), and LEA (91-180 d; 15.1%). On multivariate analysis, 30-day readmissions for LEA (AOR 3.19; 95% CI, 1.2-8.2; P = .02), VE (AOR 10.01; 95% CI, 3.1-32.9; P < .001), IVC filter (AOR 2.98; 95% CI, 1.3-6.9; P = .01), PLB (AOR 2.86; 95% CI, 1.71-4.79; P < .001), and PCN (AOR 3.09; 95% CI, 1.29-7.37; P = .01) were associated with 90-day mortality.
  
  
  CONCLUSIONS
  Inpatient IR procedures have high 30-day all-cause readmission rates, which can be associated with increased 90-day mortality. Further evaluation to determine preventable causes for readmission may impact 90-day mortality.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215. Electronic address: asarwar@bidmc.harvard.edu.
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Lujia
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Nihara
authors.initials: N
authors.lastname: Chakrala
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Weinstein
authors.affiliation: Department of Radiology, University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Max P
authors.initials: MP
authors.lastname: Rosen
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors