Preexisting Conditions Determine the Occurrence of Unplanned Readmissions after Procedures for Treatment of Peripheral Arterial Disease.

BACKGROUND

Readmissions after surgical procedures are increasingly considered a metric to indicate the quality of care received during the index hospitalization. Patients with peripheral arterial disease (PAD) requiring peripheral vascular interventions (PVIs) or lower extremity bypasses (LEBs) often have several serious medical comorbidities. Risk factors associated with readmission after PVI and LEB have previously been identified. The purpose of this study is to compare the readmissions among patients receiving PVI and LEB procedures to identify risk factors associated with high risk of readmission.

METHODS

The 2013 Procedure-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Program User Files were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing PVI and LEB were assessed. Odds ratios (ORs) with confidence intervals (CIs) for PVI versus LEB groups within the subgroups of these characteristics were then obtained where significant associations existed between the study groups.

RESULTS

A total of 3,742 patients (males: 2,384 [63.7%] and females: 1,358 [36.3%]) underwent surgical procedures for lower extremity PAD during the year 2013. Among these patients, 1,096 (29.3%) were treated with endovascular interventions and 2,646 (70.7%) were treated with surgical bypasses. Patients were divided into 2 groups: PVI (n = 1,096) and LEB (n = 2,646) groups. Each group was further subdivided into 2 groups: readmission and no readmission. The incidence of readmission was as follows: PVI group (n = 147, 13.4%) and LEB (n = 425, 16.1%). The PVI and LEB groups showed a significant association with readmission within the following factors: dialysis dependency (PVI 32.6% vs. LEB 19.1%, OR: 2.06, CI: 1.13-3.75, P < 0.001), emergency operation (PVI 40.4% vs. LEB 18.7%, OR: 2.96, CI: 1.45-6.03, P < 0.001), chronic obstructive pulmonary disease (COPD; PVI 23.7% vs. LEB 14.6%, OR: 1.82, CI: 1.08-3.07, P = 0.001), cardiac arrest (PVI 45.5% vs. LEB 9.5%, OR: 7.92, CI: 1.21-51.9, P = 0.017), and body mass index > 30 (PVI 9.9% vs. LEB 18.4%, OR: 0.49, CI: 0.33-0.73, P = 0.009).

CONCLUSIONS

Readmissions after lower extremity endovascular or surgical interventions can be used as a quality metric. Patients with dialysis dependency, COPD, in need of emergent operation, or having cardiac arrest are highly likely to be readmitted if treated with endovascular interventions. Similarly, patients with high body mass index are highly likely to be readmitted if treated with open surgical bypasses.