Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia.
Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
J Vasc Surg. 2019 Sep;70(3):996-1006.e7. doi: 10.1016/j.jvs.2019.01.079.
Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD.
PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and CINAHL were searched systematically from inception until May 20, 2018. Studies were eligible for inclusion if they included patients with diagnosed PAD undergoing revascularization and reported the readmission rate and a statistical evaluation of the association of at least one risk factor with readmission. Studies were excluded if data for other procedures could not be distinguished from revascularization. Two authors undertook study selection independently with the final inclusion decision resolved through consensus. The PRISMA and Meta-analyses of Observational Studies in Epidemiology guidelines were followed regarding data extraction and quality assessment, which was performed by two authors independently. Data were pooled using a random effects model.
The primary outcome was readmission within 30 days of revascularization. Fourteen publications reporting the outcomes of 526,008 patients were included. Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4% (95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the following risk factors had a significant association with readmission: female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR, 1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI, 1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62), emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39; 95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95% CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31), dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95% CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47).
Approximately one in six patients undergoing revascularization for PAD are readmitted within 30 days of their procedure. This review identified multiple risk factors predisposing to readmission, which could potentially serve as a way to target interventions to reduce readmissions.
外周动脉疾病（PAD）血运重建后再次住院的情况经常被报道。目前对于再次住院的具体频率和危险因素尚无共识。本综述旨在确定 PAD 血运重建后 30 天内再次住院的发生率和危险因素。
系统检索 PubMed/Medline（Ovid）、Scopus、Web of Science、Cochrane 图书馆和 CINAHL，检索时间截至 2018 年 5 月 20 日。如果研究纳入了确诊为 PAD 且接受了血运重建的患者，并报告了再入院率以及至少一个危险因素与再入院的关联的统计学评估，则这些研究符合纳入标准。如果其他手术的数据无法与血运重建区分开，则排除这些研究。两位作者独立进行研究选择，最终的纳入决定通过共识解决。关于数据提取和质量评估，我们遵循了 PRISMA 和观察性研究的 Meta 分析指南，这两个过程都是由两位作者独立进行的。使用随机效应模型对数据进行汇总。
主要结局是血运重建后 30 天内再次住院。有 14 篇报告了 526008 例患者结局的文献被纳入。报告的再入院率范围为 10.9%至 30.0%，平均为 16.4%（95%置信区间 [CI]，15.1%-17.9%）。Meta 分析表明，以下危险因素与再入院有显著关联：女性（比值比 [OR]，1.13；95%CI，1.05-1.21）、黑种人（OR，1.36；95%CI，1.28-1.46）、依赖功能状态（OR，1.72；95%CI，1.43-2.06）、严重肢体缺血（OR，2.12；95%CI，1.72-2.62）、急诊入院（OR，1.75；95%CI，1.43-2.15）、高血压（OR，1.39；95%CI，1.26-1.54）、心力衰竭（OR，1.82；95%CI，1.50-2.20）、慢性肺部疾病（OR，1.19；95%CI，1.08-1.32）、糖尿病（OR，1.47；95%CI，1.32-1.63）、慢性肾脏病（OR，1.93；95%CI，1.62-2.31）、透析依赖（OR，2.08；95%CI，1.75-2.48）、吸烟（OR，0.83；95%CI，0.78-0.89）、术后出血（OR，1.70；95%CI，1.23-2.35）和术后败血症（OR，4.13；95%CI，2.02-8.47）。
大约六分之一的 PAD 血运重建患者在术后 30 天内再次住院。本综述确定了多个易导致再次住院的危险因素，这可能有助于确定降低再次住院率的干预措施。
