Weiss Salome, Rojas Ricardo L, Habermann Elizabeth B, Moriarty James P, Borah Bijan J, DeMartino Randall R
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn.
J Vasc Surg. 2020 Oct;72(4):1277-1287. doi: 10.1016/j.jvs.2020.01.046. Epub 2020 Apr 1.
Readmissions after aortic dissection (AD) admission are not well described. Using state-based administrative claims data, we sought to define readmission rates after AD and to identify factors associated with them.
State Inpatient Databases for Florida (2007-2012) and New York (2008-2012) were queried for AD index admissions. Admissions were stratified by initial treatment strategy: type A open surgery repair (TAOR), type B open surgery repair (TBOR), thoracic endovascular aortic repair (TEVAR), or medical management (MM). All-cause readmission rates were calculated at 30 days, 90 days, and 2 years. Logistic regression was used to identify factors associated with readmission at each time point for all type A admissions (TAOR) or type B admissions (TBOR, TEVAR, MM).
We identified 4670 patients with an AD index admission. Treatment was with TAOR in 1031 (22%), TBOR in 761 (16%), TEVAR in 412 (9%), and MM in 2466 (53%). Patients were predominantly male (59.4%) and white (61.9%), with a median age of 66 years. Overall mortality during AD index admission was 14.8% (TAOR, 15.8%; TBOR, 17.1%; TEVAR, 9.0%; MM, 14.7%; P = .002 across all groups). All-cause readmission rates were similar across treatment groups at 30 days (9.6%-11%; P = .56), 90 days (15.2%-20%; P = .26), and 2 years (49.2%-54.4%; P = .15). Higher income quartile (vs lowest) was associated with lower odds of early readmission (at 30 days and 90 days) after type B admissions but not after type A admissions. At 2 years, self-pay (vs Medicare) was associated with lower odds of readmission in both type A and type B admissions, whereas higher comorbidity count and black race (vs white) were associated with higher odds of readmission. TEVAR (vs MM) was also associated with higher odds of readmission. Cardiovascular disease was the most common cause for readmission at all time points. Emergency department readmission counts were highest after MM admissions, and ambulatory surgical admissions were highest after TBOR. Both TEVAR and MM initial costs were lower than TAOR and TBOR costs, but at 2 years, costs remained significantly lower only for MM.
In-state 30-day, 90-day, and 2-year readmission rates after AD were not associated with initial treatment type. Two-year readmissions are common. Strategies to target socioeconomic, race, and geographic factors may reduce variations in readmission patterns after AD admission.
主动脉夹层（AD）入院后的再入院情况尚未得到充分描述。利用基于州的行政索赔数据，我们试图确定AD后的再入院率，并识别与之相关的因素。
查询佛罗里达州（2007 - 2012年）和纽约州（2008 - 2012年）的州住院数据库以获取AD索引入院病例。入院病例按初始治疗策略分层：A型开放手术修复（TAOR）、B型开放手术修复（TBOR）、胸主动脉腔内修复术（TEVAR）或药物治疗（MM）。计算30天、90天和2年的全因再入院率。采用逻辑回归分析确定所有A型入院（TAOR）或B型入院（TBOR、TEVAR、MM）在每个时间点与再入院相关的因素。
我们确定了4670例有AD索引入院的患者。其中1031例（22%）接受TAOR治疗，761例（16%）接受TBOR治疗，412例（9%）接受TEVAR治疗，2466例（53%）接受MM治疗。患者以男性（59.4%）和白人（61.9%）为主，中位年龄为66岁。AD索引入院期间的总体死亡率为14.8%（TAOR为15.8%；TBOR为17.1%；TEVAR为9.0%；MM为14.7%；所有组间P = 0.002）。各治疗组在30天（9.6% - 11%；P = 0.56）、90天（15.2% - 20%；P = 0.26）和2年（49.2% - 54.4%；P = 0.15）的全因再入院率相似。较高收入四分位数（与最低四分位数相比）与B型入院后早期再入院（30天和90天）几率较低相关，但与A型入院后无关。在2年时，自费（与医疗保险相比）与A型和B型入院再入院几率较低相关，而较高的合并症计数和黑人种族（与白人相比）与再入院几率较高相关。TEVAR（与MM相比）也与再入院几率较高相关。心血管疾病是所有时间点再入院最常见的原因。MM入院后急诊科再入院次数最高，TBOR后门诊手术入院次数最高。TEVAR和MM的初始成本均低于TAOR和TBOR成本，但在2年时，仅MM的成本仍显著较低。
AD后州内30天、90天和2年再入院率与初始治疗类型无关。2年再入院很常见。针对社会经济、种族和地理因素的策略可能会减少AD入院后再入院模式的差异。
