Society For Clinical Vascular Surgery

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Gender Influences Readmission Rates Following Endovascular Aortic Aneurysm Repair
Brandon D. Downing, M.D., Ph.D., Senthil N. Jayarajan, M.D., M.S., Jeffrey Jim, M.D., MPHS.
Washington University School of Medicine in St Louis, St Louis, MO, USA.

Objectives
Hospital readmission following EVAR is associated with increased morbidity, mortality and costs. The purpose of this study is to assess the effect of gender on readmission following EVAR.
Methods
The 2013-2014 National Readmission Database was queried for EVAR. Demographics, comorbidities, complications, and causes of 30-day readmission were analyzed by gender. Logistic regression was utilized to investigate association of gender and readmission. Differences in the primary outcome by gender across subgroups were computed by adding the appropriate interaction terms to the regression models.
Results
A review of 24,911 EVARs from 2013-2014 showed a 30-day readmission rate of 10.4% (2,392 readmissions). Female gender accounted 20.0% of EVARs. Women were older (74.9 vs. 73.2 years, p<0.01) and had more emergent admissions (80.0% vs 78.4% vs. p=0.02) but had similar rates of rupture (p=0.522). Women were more likely to have a complication related to index operation (31.6% vs. 25.6%, p<0.001) including respiratory (2.5% vs. 1.6%, p<0.001), renal (7.4% vs. 6.3%, p<0.001), bleeding (14.4% vs. 7.3%, p<0.001) and sepsis (3.8% vs. 2.7%, p<0.001). Length of stay was higher in women (4.1 vs. 3.1 days, p<0.001). Women were less often discharged home after EVAR (87.1% vs. 92.8%, p<0.001).
Women had more readmissions than men (12.3% vs. 8.3%, p<0.01), but similar distribution of causes of readmission (p=0.515). Infection, cardiac and gastrointestinal problems were common causes for readmission between both groups. Cost of readmission (p=0.795) and operative procedure (p=0.069) during readmission was similar between genders.
On multivariate analysis, female gender, comorbidities and discharge location increased 30-day readmissions after EVAR. Readmissions were higher in women than men among those with peripheral arterial disease (13.3% vs. 9.9%, OR 1.25, p=0.042 for interaction).
Conclusions
Women undergoing EVAR were identified to have a higher readmission rate, especially those with peripheral vascular disease. Women appear to be more predisposed to complications and are less likely to be discharged home after EVAR. This study identifies vulnerable subgroups among women that could be selectively targeted to reduce readmissions rates after EVAR.


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