Risk factors for 30-day Hospital Readmission after Elective Abdominal Aortic Aneurysm Repair
Jonathan Bath, Jamie B. Smith, Robin L. Kruse, Todd R. Vogel.
University of Missouri, Columbia, MO, USA.
OBJECTIVES: All-cause 30-day readmissions after vascular procedures for elective abdominal aortic aneurysm (AAA) repair was evaluated.
METHODS: Inpatients (2008-2014) who underwent an AAA procedure were selected from Cerner Health Facts® database using ICD-9 procedure codes. Readmission within 30 days of discharge was determined. Chi square analysis and multivariate logistic regression models were used to identify characteristics (demographics, diagnoses, post-operative medications and laboratory results) associated with 30-day readmission.
RESULTS: 3,220 patients undergoing elective AAA procedures were identified (1,991 EVAR and 1,229 open procedures). Readmission within 30 days did not differ by procedure type (3.6% EVAR vs. 4.1% open, p = .44). Subgroup analysis revealed that device complications (OR 2.60, 95% 1.13-5.96) and higher Charlson comorbidity scores (OR 1.24, 95% CI 1.08-1.43) were risk factors for 30-day readmission following EVAR. The odds of 30-day readmission after EVAR were 47% higher for women, with men less likely to be readmitted (OR 0.53, 95% CI 0.32 - 0.88). After open procedures, 30-day readmission was associated with an infection during the index admission (OR 2.16, 95% CI 1.11-4.19). Open surgery at a teaching facility was also associated with reduced readmission (OR 0.47, 95% CI 0.23 - 0.98). Multivariable logistic regression found the following factors associated with 30-day readmission following any AAA repair: an infection during the index admission (OR 1.92, 95% CI 1.14-3.24), device complications (OR 1.91, 95% CI 1.05-3.45), history of hypertension (OR 1.77, 95% CI 1.16-2.70), white blood cell count > 11.0 (OR 1.63, 95% CI 1.05-2.52), and higher Charlson co-morbidity scores (OR 1.20, 95% CI 1.06-1.35). The most common infection was pneumonia after open procedures and UTI after EVAR. CONCLUSIONS: The risk factor most associated with 30 day readmission after any AAA repair was developing an infectious complication, however, developing a vascular complication following any AAA repair was also very strongly associated with readmission. Open AAA performed at teaching hospitals were less likely to be readmitted and gender disparity following EVAR with respect to readmission was demonstrated. Awareness of these risk factors and vulnerable groups may assist in identifying high-risk patients who might benefit from increased surveillance programs to reduce readmission. Further investigation of the causes of gender disparity and a lower threshold for open repair in women with complex anatomy may facilitate lowering readmission rates.
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