Acharya Prakash, Sethi Prince, Ranka Sagar, Alli Adam, Hance Kirk, Prasad Anand, Shah Zubair, Gupta Kamal
Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA.
Department of Radiology, University of Kansas, Medical Center, Kansas City, KS, USA.
Vascular. 2022 Apr;30(2):255-266. doi: 10.1177/17085381211011357. Epub 2021 Apr 28.
There is a paucity of data regarding six-month readmissions in critical limb ischemia patients and the influence of management strategy during index-admission [endovascular, surgical, hybrid procedure, medical therapy, and amputation]. We aimed to investigate the incidence, predictors, and impact of management strategies on six-month readmission in patients with critical limb ischemia.
A secondary analysis of the Nationwide Readmissions Database (2016-2017) was conducted. Propensity score matching was performed for subgroup analysis.
We identified 50,058 patients with primary diagnosis of critical limb ischemia. Six-month all-cause and critical limb ischemia-related readmission rate was 52.36% and 10.86%, respectively. The risk of all-cause readmission was lower with amputation but was similar among other subgroups. Patients receiving surgical [HR 0.62, CI(0.48-0.79), p < 0.001] and hybrid procedure [HR 0.65 (0.46-0.93), p = 0.02] had lower risk of unplanned critical limb ischemia-related readmission compared to endovascular, though the risk of unplanned revascularization/amputation during readmission was similar between the three strategies. The risk of non-critical limb ischemia-related readmission was higher with surgical [HR 1.13, CI(1.04-1.23), = 0.003] and hybrid procedure [HR 1.17, CI(1.08-1.28), < 0.001], driven by increased procedure-related/wound complications. Eventhough endovascular patients were older with more severe critical limb ischemia presentation, a lower proportion received home-health or placement upon discharge from index-admission. This could account for higher readmission without higher repeat revascularization in endovascular group.
The risk of critical limb ischemia and non-critical limb ischemia-related readmission differ according to the management strategy. Significant differences in discharge disposition exist depending on revascularization strategy. Study findings identify opportunities for reducing readmissions by focusing on nonprocedural aspects like wound-care, discharge planning and placement.
关于严重肢体缺血患者的6个月再入院情况以及首次入院期间管理策略[血管内治疗、手术、杂交手术、药物治疗和截肢]的影响，相关数据较少。我们旨在调查严重肢体缺血患者6个月再入院的发生率、预测因素以及管理策略的影响。
对全国再入院数据库（2016 - 2017年）进行二次分析。采用倾向评分匹配进行亚组分析。
我们确定了50,058例以严重肢体缺血为主要诊断的患者。6个月全因再入院率和与严重肢体缺血相关的再入院率分别为52.36%和10.86%。截肢患者的全因再入院风险较低，但在其他亚组中相似。与血管内治疗相比，接受手术治疗[风险比（HR）0.62，置信区间（CI）（0.48 - 0.79），p < 0.001]和杂交手术[HR 0.65（0.46 - 0.93），p = 0.02]的患者发生计划外严重肢体缺血相关再入院的风险较低，尽管三种策略在再入院期间计划外血管重建/截肢的风险相似。手术治疗[HR 1.13，CI（1.04 - 1.23），p = 0.003]和杂交手术[HR 1.17，CI（1.08 - 1.28），p < 0.001]导致的非严重肢体缺血相关再入院风险较高，这是由手术相关/伤口并发症增加所致。尽管血管内治疗的患者年龄较大，严重肢体缺血表现更严重，但从首次入院出院时接受家庭健康护理或安置的比例较低。这可能解释了血管内治疗组再入院率较高但再次血管重建率不高的原因。
严重肢体缺血和非严重肢体缺血相关再入院的风险因管理策略而异。根据血管重建策略，出院处置存在显著差异。研究结果表明，通过关注伤口护理、出院计划和安置等非手术方面，有机会降低再入院率。
