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Independent Predictors of Readmission after Femoral to Popliteal Artery Bypass Grafting in Diabetics
Khanjan H. Nagarsheth, MD, Jonathan Schor, MD, Matthew D'Alessandro, MD, Kuldeep Singh, MD, Saqib Zia, MBBS, Jonathan Deitch, MD.
Staten Island University Hospital, Staten Island, NY, USA.
OBJECTIVES:
To determine which factors contribute to hospital readmission for diabetic patients within 30-days of femoral to popliteal artery bypass (FPB) surgery, we performed a database review.
METHODS:
The National Surgical Quality Improvement Program (NSQIP) database was queried from the years 2005 to 2011, to identify diabetic patients who underwent FPB. Patients were divided into two groups, those who were readmitted within 30-days of operation (RA) and those who were not readmitted (NRA). Patient demographics, comorbidities, perioperative data, and outcomes were compared.
RESULTS:
Of the 5523 patients identified, 334 were in the RA group and 5189 were in the NRA group. There were 208 vein bypasses in the RA group and 2949 vein bypasses in the NRA group. The remainder were prosthetic conduit. Difference in bypass conduit approached but did not achieve statistical significance (p=0.051).
The RA group had a higher proportion of patients with medical comorbidities including: ventilator dependence (2.1% v. 0.1%, p<0.01), CHF (8.7% v. 3.1%, p<0.01), recent MI (4.5% v. 2%, p<0.01), and insulin dependence (59.6% v. 53.6%, p=0.03) compared to the NRA group. Pre operative vascular disease was more severe in the RA group as well with rest pain/gangrene (50.9% v. 39.1%, p<0.01) and history of prior amputation (73.1% v. 49.8%, p<0.01) both higher in the RA group. The RA group also had a higher proportion of emergency procedures (11.4% v. 4.4%, p<0.01), longer operative time (226±11.5 min v. 208.4±2.6 min, p<0.01) and longer prior hospital LOS (16.5±1.8 days v. 8±0.3 days, p<0.01). The RA group also was taken back to the OR more frequently during the index admission (36.2% v. 15.3%, p<0.01) than the NRA group. Pre-operative HTN (odds ratio [OR] 46.7, confidence interval [CI] 34.6 to 62.9) and rest pain/gangrene (OR 50.1, CI 36.4 to 69.1) were found to be the only independent predictors of readmission on multivariate analysis.
CONCLUSIONS:
Insulin dependence and preoperative cardiac comorbidities are not predictive of readmission rates after FPB in diabetic patients. The presence of critical limb ischemia is the most predictive factor for 30-day readmission after FPB in diabetic patients.
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