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Unplanned Return to Operating Room after Carotid Endarterectomy is Associated with Increased Risk of Readmission
Faisal Aziz, Katelynn Ferranti, Ali Tarik, Marco Huesch.
Penn State University, Hershey, PA, USA.

Objectives
Readmissions to hospital after surgical operations reflect poor quality of healthcare are considered preventable and are associated with increased costs of care. In the era of decreasing healthcare reimbursements, identification of preventable complications is becoming a focus for attention. Despite advances in endovascular surgery, carotid endarterectomy (CEA) remains the gold standard treatment for symptomatic carotid disease and asymptomatic, high-grade carotid stenosis. The purpose of this study is to retrospectively review the factors associated with hospital readmission after carotid endarterectomy.
Methods
The 2015 CEA –targeted American College of Surgeons (ACS-NSQIP) database and generalized 2015 general and vascular surgery ACS-NSQIP PUF were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing CEA surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery.
Results
A total of 4199 patients (Males 61%, , Females 39%) were identified in NSQIP database, who underwent CEA during the year 2015. Indications for operations included: asymptomatic, high-grade stenosis (54.6%), ipsilateral stroke (20%), ipsilateral transient ischemic attack (16%), amaurosis fugax (7.6%) and not documented (1.62%). A total of
292 patients (6.9%) were readmitted within 30 days of index operation. On multivariable analysis, risk factors, associated with readmission included: unplanned return to the operating room (OR 25, CI 7.2-87.3, p=0.000), superficial surgical site infection (OR 12.6, CI 4.6-34.8, p=0.000, pulmonary embolism (OR 12.4, CI2.9-51.8, p=0.001), urinary tract infection (OR 8.2, CI 3.9-16.9, p=0.000), myocardial infarction (OR 5.5, CI 2.6-11.6, p=0.000), transient ischemic attack (OR 5.5, CI 2.8-10.8, p=0.000), pneumonia (OR 4.7, CI 1.9-10.9, p=0.000), stroke (OR4.3, CI2.6-7.23, p=0.000), dialysis dependency (OR 3.3, CI 1.5-7, p=0.0002), re-intubation (OR2.8, CI 1.3-6.5, p=0.013) and history of COPD (OR 1.5, CI 1 – 2.1, p=0.04).
Conclusions
Readmission after CEA surgery is a serious complication. Various factors put a patient at a high risk for readmission. Return to operating room, wound infection, pulmonary embolism, urinary tract infection, TIA, dialysis dependency, re-intubation and history of COPD are independent risk factors for hospital readmission. Return to operating room is associated with a 25-fold increase in hospital readmission.


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