Comparison of Factors Associated with Readmission After Lower Extremity Endovascular Interventions with Those Associated with Readmission After Surgical Bypass
Ali Tarik, Erik Lehman, MS, Faisal Aziz.
Penn State University, Hershey, PA, USA.
Hospital readmissions after surgical operations are considered preventable and used as quality metric. Patients with peripheral arterial disease requiring endovascular (LEE) or surgical interventions (LEO) often have several serious medical comorbidities. Our group has previously identified risk factors associated with readmission after endovascular interventions and after open surgical bypasses. The purpose of this study is to compare the readmissions between these two modalities to identify risk factors associated with high risk of readmission.
The 2013 Procedure –targeted American College of Surgeons (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Program User Files were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing LEE and LEO were assessed. Odds ratios with confidence intervals were then obtained for significant factors associated with hospital readmission within 30 days after surgery.
A total of 1,096 patients underwent LEE and 2,646 patients underwent LEO during year 2013. Each of these groups was divided into two sub-groups, forming a total of four sub-groups:
Readmission after LEE (n=147,13.4%), No Readmission after LEE (n=949, 86.6%), Readmission after LEO (n=425, 16.1%) and No Readmission after LEO (n=2221, 83.9%). Between LEE Readmission group and LEO Readmission group, following variables were significantly different: dialysis dependency (LEE 32.6% vs. LEO 19.1%, OR 2.1, CI 1.1-3.8, p<0.001), emergency operation (LEE 40.4% vs. LEO 18.7%, OR 2.9, CI 1.5-6, p<0.001), COPD (LEE 23.7% vs. LEO 14.6%, OR 1.8, CI 1.1-3.1, p<0.001), cardiac arrest (LEE 45.4% vs. LEO 9.5%, OR 7.9, CI 1.2-51.9, p<0.01) and BMI>30 (LEE 9.9% vs. LEO 18.4%, OR 0.49, CI 0.3-0.7, p<0.001).
Readmission after lower extremity endovascular or surgical interventions is a serious complication. Patients with dialysis dependency, COPD, in in need of emergent operation or having cardiac arrest are highly likely to be readmitted if treated with endovascular interventions. Similarly, patients with high BMI are highly likely to be readmitted if treated with open surgical bypasses.
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