Unplanned Early Hospital Readmissions in a vascular surgery population
Alexandra Papadopoulos, RN, Sue Devries, RN, Janice Montbriand, PhD, Naomi Eisenberg, PT, Wayne Johnston, MD, Graham Roche-Nagle, MD.
Toronto General Hospital, Toronto, ON, Canada.
OBJECTIVES: Readmission is associated with high mortality, morbidity, and cost. Vascular surgery patients have high readmission rates, documented as high as 25%. We characterized the frequency and causes of early, unplanned readmissions after elective and emergency vascular surgery at our institution to identify modifiable targets for reducing readmission rates.
METHODS: The medical records of all patients (n = 3324) admitted by the vascular surgery service at a single tertiary care institution over a 5 year period From 2007 to 2012, were retrospectively reviewed. Charts were individually hand screened to categorize readmission diagnosis and identify characteristics that may be contributing to readmission. Readmissions to our hospital were categorized as planned or unplanned and related or unrelated to the index procedure. Continuous variables are reported by mean and standard deviation, categorical by count or percent. Chi-square analyses were used to compare proportion(s) of count variables, while t-tests were used to compare continuous variables.
RESULTS: The early unplanned readmission rate to the same institution was 12.6% (n =421). Of this cohort, 47 patients were found to have >1 readmission following their initial stay. Our readmission rate ranged from 11.8% to 14.1% over the 5 years resulting in an average readmission rate of 12.7%. There were similar readmissions for males (12.9%) and females (12.3%) and readmitted patients were found to have on average 3.4 comorbidities (SD=1.817). 40.4% (n=151) of patients had ≥ 5 comorbidities. The majority of patients were admitted emergently on initial admission (60%, n= 224). Of those who were admitted emergently on the first admission, 68.8% were again admitted emergently upon readmission. The most common pathology resulting in the initial admission in the unplanned readmissions was peripheral vascular disease (53%). The commonest readmission diagnosis was worsening peripheral vascular disease (21.7%), graft issues (12.6%) or surgical site infections (10.2%).
CONCLUSIONS: To reduce readmission rates effectively, institutions must identify high-risk patients. Select pathologies, comorbidities and postoperative complications contribute to unplanned readmissions. The most frequent pathology resulting in readmission was peripheral vascular disease. The most frequent preventative reason for readmission was surgical site infection. Interventions focused on early assessment of clinical status and wounds in addition to avoidance of infectious complications could help reduce readmission rates. By focusing on subgroups at risk for readmission, preventative resources can be efficiently targeted.
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