Evaluation of Readmission Rates for Carotid Endarterectomy Versus Carotid Artery Stenting in the US Medicare Population

Galiñanes, Edgar Luis; Dombroviskiy, Viktor Y.; Hupp, Colleen S.; Kruse, Robin L.; Vogel, Todd R.

doi:10.1177/1538574413518120

Cited by 23 publications

(27 citation statements)

References 26 publications

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“…Consistent with prior investigators, we found that CAS patients were more likely to be readmitted than CEA patients (2). The difference in the risk of readmission is likely driven in part by patient selection.…”

Section: Discussionsupporting

confidence: 91%

“…Among Medicare patients undergoing carotid revascularization, 9.6% were readmitted within 30 days of discharge (2,6–9). A high proportion of readmissions occurred within the first 7 days of hospital discharge, and readmissions were associated with a wide range of principal diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…had symptoms attributable to their carotid disease) was identified using the following ICD-9-CM codes previously reported in literature: 362.3(0–7), 362.84, 433.11, 433.31, 434.01, 434.91, 435. (0–3,8,9), and 781.4 (2,4,5). The primary outcome of interest was hospital readmission within 30-days of discharge from a hospitalization during which a carotid revascularization procedure had been performed.…”

Section: Methodsmentioning

confidence: 99%

“…Prior research has focused on the safety and efficacy of carotid revascularization, but few investigators have considered short term readmission as a clinically important outcome (2). However, the potential importance of readmissions following carotid revascularization has increased dramatically with the development of a measure of hospitals’ 30-day risk-standardized readmission rates (RSRR) following vascular procedures (3), with implications for potential financial penalties for hospitals with excess readmissions.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, like many vascular procedures, carotid revascularization can be accomplished through an open or endovascular approach (carotid endarterectomy [CEA] and carotid artery stenting [CAS], respectively). Although prior research has shown that patients undergoing CAS are at increased risk of readmission compared with patients undergoing CEA (2), it is not known whether differences in hospitals’ proportional use of CAS among all carotid revascularization procedures are associated with differences in hospital 30-day readmission rates.…”

Section: Introductionmentioning

confidence: 99%

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Readmissions After Carotid Artery Revascularization in the Medicare Population

Al‐Damluji

Dharmarajan

Zhang

et al. 2015

Journal of the American College of Cardiology

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Background In appropriately selected patients with severe carotid stenosis, carotid revascularization reduces ischemic stroke. Prior clinical research has focused on the efficacy and safety of carotid revascularization, but few investigators have considered readmission as a clinically important outcome. Objectives To examine frequency, timing, and diagnoses of 30-day readmission following carotid revascularization; to assess differences in 30-day readmission between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS); to describe hospital variation in risk-standardized readmission rates (RSRR); and to examine whether hospital variation in procedural choice (CEA vs. CAS) was associated with differences in RSRRs. Methods We used Medicare fee-for-service administrative claims data to identify acute care hospitalizations for CEA and CAS from 2009–2011. We calculated crude 30-day all-cause hospital readmissions following carotid revascularization. To assess differences in readmission after CAS compared with CEA, we used Kaplan-Meier survival curves and fitted mixed-effect logistic regression. We estimated hospital RSRRs using hierarchical generalized logistic regression. We stratified hospitals into 5 groups by their proportional CAS use and compared hospital group median RSRRs. Results Of 180,059 revascularizations from 2,287 hospitals, CEA and CAS were performed in 81.5% and 18.5% of cases, respectively. The unadjusted 30-day readmission rate following carotid revascularization was 9.6%. Readmission risk after CAS was higher than after CEA. There was modest hospital-level variation in 30-day RSRRs (Median: 9.5%, Range: 7.5%–12.5%). Variation in proportional use of CAS was not associated with differences in hospital RSRR (range of median RSRR across hospital quartiles: 9.49%–9.55%, P 0.771). Conclusions Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30-days of discharge. Compared with CEA, CAS was associated with higher readmission risk. However, hospitals’ RSRR did not differ by their proportional CAS use.

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Section: Discussionsupporting

confidence: 91%