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Objective: Hospital readmission is associated with high cost and is being increasingly scrutinized as a target for quality improvement in surgical practice. Elective endovascular repair of abdominal aortic aneurysm (EVAR) is generally well-tolerated; however, incidence and reasons for readmission after EVAR are not well studied. We aim to determine the incidence and perioperative patient-centered risk factors for readmission within 30 days after EVAR.
Methods: All patients who underwent EVAR in 2012 and 2013 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Vascular Database (n= 3886). Pre-operative data, operation-specific variables and post-operative outcomes were compared between those who were readmitted and those who were not. Multivariable logistic regression was then used to determine independent predictors of readmission.
Results: The unadjusted 30-day readmission rate following EVAR was 8.1%. 95.8% of these readmissions were defined as unplanned. Of all readmissions, 55% of these were for reasons related to the procedure. Median time to readmission following EVAR was 14 days (interquartile range 8-19 days). Significant pre-operative risk factors associated with readmission were female gender, insulin-dependent diabetes, history of severe COPD, pre-operative steroid use, congestive heart failure, hypertension, end stage renal disease and prior abdominal aortic surgery (P <.05). Operative variables significantly associated with readmission were bilateral groin cutdown, need for lower extremity revascularization, aortic bare metal stent placement, need for intraoperative or postoperative transfusion, and longer operative times (P <.05). Multiple post-operative medical complications were independently predictive of readmission, including myocardial infarction, deep venous thrombosis, acute kidney injury and urinary tract infection. Surgical complications that were independently predictive of readmission were any wound complication (OR 9.95, 95% CI 5.31-18.64, P < .001) and need for re-operation (OR 15.93, 95% CI 9.46-26.81, P < .001), which most commonly was incision and drainage of fluid collection of the lower extremity (n=9). Readmitted patients ultimately had significantly higher rates of 30 day mortality (3.50% vs. 1.06%, P <0.001).
Conclusions: Readmissions remains a costly problem following vascular surgery and is significantly associated with 30-day mortality after EVAR. More intense focus on those variables which can be intervened and complications that can be avoided will be an important step in preventing readmission.