Not All Vascular Surgery Readmissions Are Created Equal
Lucia Qian, Rami Tadros, Chien Yi Png, Scott Safir, Melissa Tardiff, Anthony Bui, Daniel Han, Ageliki Vouyouka, Windsor Ting, Peter Faries.
Mount Sinai Hospital, New York, NY, USA.
Objectives: To investigate the risk factors associated with and causes of readmission of patients following an inpatient vascular surgery stay. Methods: 1000 randomly selected patients who were admitted to the vascular surgery inpatient service between 2011 and 2014 were retrospectively identified. 28 patients were excluded due to missing data points. Readmissions were measured both 30 days and 1 year after discharge. The readmissions were characterized as planned/unplanned and related/unrelated. Planned readmissions were defined as readmissions scheduled at the time of the initial admission. Related readmissions were defined as readmissions clinically related to the initial admission. Predictors for readmission were analyzed using chi-square tests and t-tests. Differences in types of readmission were analyzed using binomial tests and chi-square goodness of fit tests. Results: The overall all-cause 30-day readmission rate was 23.3% and the overall all-cause 1-year readmission rate was 53.8%. Compared to non-readmitted patients, readmitted patients were diabetic (69%), hypertensive (92%), hyperlipidemic (66%), former or active smokers (62%), and associated with other cardiovascular comorbidities (87%), p < 0.01. There were no differences in age or sex between readmitted and non-readmitted patients. Of the 30-day readmissions, related/unplanned readmissions were the most common (p < 0.001) and constituted 36.7% of all 30-day readmissions (Table 1). Of the 1-year readmissions, unrelated/unplanned readmissions occurred most frequently (38.4%) (p < 0.001), although related/unplanned readmissions also contributed significantly, contributing to 25.8% of all 1-year readmissions (Table 2). Major causes of related/unplanned readmissions included surgical site infection and healing problems. Other top causes for readmissions included amputation and wound debridement for related/planned readmissions; peripheral intervention of alternate vascular bed for unrelated/planned readmissions; and exacerbation of an acute medical comorbidity or acute infection for unrelated/unplanned readmissions. Conclusions: Theoretically, related/unplanned readmissions are the most preventable type. Identifying the causes of these readmissions may allow us to reduce overall readmission rates. In our cohort, between 2011 and 2014, a total of 226 patients were readmitted within 30 days of their inpatient vascular surgery stay. If the 83 (36.7%) related/unplanned readmissions could have been prevented, the overall 30-day readmission rate could have been reduced from 23.3% to as low as 14.7%.
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