Back to 2016 Annual Symposium Abstacts

Objectives: Thirty-day readmission is used as a quality of care indicator. Although predictors of vascular surgery readmissions have been reported, the details of the readmissions are unclear. Our objective was to analyze the details of our institution’s vascular surgery service readmissions for quality improvement and to better understand which may be preventable.
Methods: A retrospective review and analysis of a university teaching hospital was conducted from October 2012 to March 2015. All patients with inpatient status discharged the vascular surgery service and subsequently readmitted within thirty days were included.
Results: There were 135 readmissions out of 649 (20.8%) discharges. Demographics were Caucasian (59.5%), male (64.4%), 66 +/- 11 years of age. The most common comorbidities were diabetes (56.3%), coronary artery disease (40%), congestive heart failure (CHF) (23.7%), and chronic obstructive pulmonary disease (19.3%). Index operations were open lower extremity procedures (LE) (38.5%), diagnostic angiograms (17%), endovascular LE procedures (11.9%), dialysis access (6.7%), carotid/cerebrovascular procedures (7.4%), major amputations (5.9%), aorta/abdominal procedures (5.2%), and no procedures (7.4%). Index length of stay (LOS) was 7.5 +/- 6.7 days. Initial disposition was to home (35%), home with services (18%), a skilled nursing facility (25%), rehabilitation facility (10%), and nursing home (4%). Thirty day readmissions were for planned procedures (21.5%), surgical complications (37.8%), and medical causes (40.7%). Planned readmissions included procedures at the same site (79.3%), different site (13.8%), and podiatry procedures (6.9%). Surgical causes for readmission were surgical site infections (64%), graft failure (20%), bleeding (8%), and unplanned podiatry procedures (10%). Most common causes for medical readmissions include malaise/failure to thrive (14.5%), CHF complications (14.5%), other infections/wounds (10.9%), non-surgical bleeding (5.4%), dialysis complications (5.4%), and acute renal failure (3.6%). Index readmission LOS was 7.4 +/- 7.2 days. Sources of readmission included clinic 38%, emergency room 56%, and direct readmission 6%. Readmission within 7 days was 35%. There was no difference in comorbidities, index operation, or reason for readmission for days 0-7 versus days 8-30.
Conclusions: Causes of 30 day readmission are multifactorial including many planned and unrelated medical readmissions in this high risk populations. Characterizing these readmissions can be used for quality improvement and to help determine what percentage are not attributable to surgeons and hospitals.