Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA.
J Vasc Surg. 2013 Apr;57(4):955-62. doi: 10.1016/j.jvs.2012.09.077. Epub 2013 Jan 17.
Thirty-day unplanned readmission after lower extremity bypass represents a large cost burden and is a logical target for cost-containment strategies. We undertook this study to evaluate factors associated with unplanned readmission after lower extremity bypass.
This is a retrospective analysis from a prospective institutional registry. All lower extremity bypasses for occlusive disease from January 1995 to July 2011 were included. The primary end point was 30-day unplanned readmission. Secondary end points included graft patency and limb salvage.
Of 1543 lower extremity bypasses performed, 84.5% were for critical limb ischemia and 15.5% were patients with intermittent claudication. Twenty-seven patients (1.7%) died in-house and were excluded from further analysis. Of 1516 lower extremity bypasses analyzed, 42 (2.8%) were in patients with a planned readmission within 30 days, and 349 (23.0%), in patients with an unplanned readmission. Most unplanned readmissions were wound related (62.9%). By multivariable analysis, preoperative predictive factors for unplanned readmission were dialysis dependence (odds ratio [OR], 1.73; P = .004), tissue loss indication (OR, 1.62; P = .0004), and history of congestive heart failure (OR, 1.43; P = .03). Postoperative predictors included distal inflow source (OR, 1.38; P = .016), in-hospital wound infection (OR, 8.30; P < .0001), in-hospital graft failure (OR, 3.20; P < .0001), and myocardial infarction (OR, 1.96; P < .04). Neither index length of stay nor discharge disposition independently predicted unplanned readmission. Unplanned readmission was associated with loss of assisted primary patency (hazard ratio, 1.39; 95% confidence interval, 1.08-1.80; P = .01) and long-term limb loss (hazard ratio, 1.68; 95% confidence interval, 1.23-2.29; P = .001).
Thirty-day unplanned readmission is a frequent occurrence after lower extremity bypass (23.0%). Stratifying patients by risk factors associated with unplanned readmission is essential for quality improvement and equitable resource allocation when disease-specific bundling strategies are being derived.
下肢旁路术后 30 天内的非计划性再入院是一个巨大的经济负担，也是控制成本策略的一个合理目标。我们进行这项研究是为了评估与下肢旁路术后非计划性再入院相关的因素。
这是一项来自前瞻性机构登记的回顾性分析。1995 年 1 月至 2011 年 7 月期间，所有因阻塞性疾病而行下肢旁路术的患者均被纳入研究。主要终点是 30 天内的非计划性再入院。次要终点包括移植物通畅率和肢体存活率。
在 1543 例下肢旁路术中，84.5%为严重肢体缺血患者，15.5%为间歇性跛行患者。27 例（1.7%）院内死亡患者被排除在进一步分析之外。在分析的 1516 例下肢旁路术患者中，42 例（2.8%）为 30 天内计划再入院患者，349 例（23.0%）为非计划性再入院患者。大多数非计划性再入院与伤口相关（62.9%）。多变量分析显示，非计划性再入院的术前预测因素包括透析依赖（比值比 [OR]，1.73；P =.004）、组织缺失指征（OR，1.62；P =.0004）和充血性心力衰竭病史（OR，1.43；P =.03）。术后预测因素包括远端血流源（OR，1.38；P =.016）、院内伤口感染（OR，8.30；P <.0001）、院内移植物失败（OR，3.20；P <.0001）和心肌梗死（OR，1.96；P <.04）。住院时间和出院去向均不能独立预测非计划性再入院。非计划性再入院与辅助性原发性通畅率丧失（危险比，1.39；95%置信区间，1.08-1.80；P =.01）和长期肢体丧失（危险比，1.68；95%置信区间，1.23-2.29；P =.001）相关。
下肢旁路术后 30 天内非计划性再入院的发生率较高（23.0%）。对与非计划性再入院相关的危险因素进行分层，对于在制定特定疾病捆绑策略时进行质量改进和公平资源分配至关重要。
