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An Evaluation of All-Cause 30-Day Readmission after Carotid Procedures
Todd R. Vogel, MD, MPH, Ryan J. Kim, MD, Robin L. Kruse, PhD.
University of Missouri Hospital & Clinics, Columbia, MO, USA.

OBJECTIVES: Readmissions after vascular surgery has come under scrutiny in an effort to contain healthcare costs. This study evaluated reasons for all-cause 30-day readmissions after carotid endarterectomy (CEA) and carotid stenting (CAS).
METHODS: Patients admitted between September 2008 and February 2014 who underwent a carotid procedure were selected from the Cerner Health Facts® database using ICD-9-CM procedure codes (index admission). AHRQ’s Clinical Classifications Software was used to group diagnosis codes into clinically relevant groups. Readmission within 30 days of discharge was determined. Chi-square analysis determined characteristics of the index admission associated with readmission.
RESULTS: 8,815 patients undergoing elective carotid procedures were identified: 7,532 CEA and 1,283 CAS. Mean age was 70.4 years. Over half (58.5%) of patients were male and 90.2% were Caucasian. During the index admission, CAS was more often performed on patients with symptomatic cerebrovascular disease, cardiac dysrhythmias, and congestive heart failure. Endarterectomies were more common among those who had asymptomatic cerebrovascular disease and hypertension. Factors associated with readmission included history of an abdominal aortic aneurism (AAA), chronic obstructive pulmonary disease, venous embolism and thrombosis (DVT), congestive heart failure (CHF), chronic heart disease, peripheral artery disease (PAD), and device complications (Table I). The diagnoses recorded at readmission for CEA and CAS were similar and included asymptomatic cerebrovascular disease, chronic heart disease, hypertension, peripheral artery disease, and mental health disorders.
CONCLUSIONS: Diagnoses which were most predictive of a 30-day readmission after carotid procedures were most often associated with an index hospital complication including postoperative stroke, DVT, and bleeding. Concomitant vascular disease including the diagnoses of an AAA and PAD as well as expected comorbidities including CHF were also highly predictive of readmission. Unexpected conditions, including mental health disorders, play a significant role in readmission in this population. Further detailed analysis for the reasons for readmission are essential as readmission for existing patient conditions may be unfounded for the provider and/or institution to be penalized.
Index Hospital Admission Diagnoses Associated with 30-day Readmission After All Carotid Procedures
DiagnosesRelative Risk (95% Confidence Interval)P-value
Congestive heart failure1.62 (1.08 - 2.41).019
Chronic obstructive pulmonary disease1.41 (1.04 - 1.93).028
Chronic heart disease1.52 (1.21 - 1.92).0004
Abdominal aortic aneurism, without rupture3.12 (1.90 - 5.13).0001
Peripheral artery disease2.28 (1.77 - 2.95)<.0001
Venous embolism or thrombosis2.48 (1.42 - 4.34).004
Postoperative stroke3.00 (1.39 - 6.49).016
Hemorrhage2.14 (1.25 - 3.66).005
Mental health disorders1.41 (1.09 - 1.82).008

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