Factors Associated with Increased Risk of Unplanned Hospital Readmission after Endovascular Aortoiliac Interventions

Abstract

Objectives Readmissions to hospital after surgical procedures are considered as reflective of poor quality of healthcare provided during the index hospitalization and are associated with increased costs of healthcare. Aortoiliac occlusive disease represents an aggressive form of atherosclerotic disease and has been traditionally treated with open surgical bypasses. Endovascular interventions for aortoiliac occlusive disease are associated with comparable outcomes to open surgical procedures. The purpose of this study is to review the factors associated with hospital readmission after aortoiliac endovascular interventions.MethodsThe 2015 procedure targeted American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and general and vascular surgery NSQIP participant user file (PUF) were used for this analysis. Patient, diagnosis and procedure characteristics of patients undergoing aortoiliac endovascular interventions were reviewed. Bivariate analysis was used to identify the relationship between the independent variables and 30-day readmission. The significant variables from the bivariate analysis were used to generate a multivariable logistic regression model. The predicted probability of readmission was calculated.ResultsOut of 823 patients, 86 were readmitted. Readmission was related to the principal procedure in 48 (73.9%) patients. A total of 61 (7%) patients underwent an unplanned operation within 30 days after the index procedure. A multivariable logistic regression model identified the following variables to be significantly associated with 30-day risk of readmission: the use of pre-procedural beta blocker (OR = 2.06, 95% CI = 1.23 - 3.45, P < 0.01), external/internal iliac intervention (OR = 1.95, 95% CI = 1.18 - 3.20, P <0.01), critical limb ischemia (OR = 1.80, 95% CI = 1.10 - 2.94, P <0.05), and unplanned return to the operating room (OR = 11.65, 95% CI = 6.35 - 21.35, P <0.01). The predicted probability of readmission was as follows: 5.5% for critical limb ischemia, 5.9% for external iliac artery angioplasty/stenting, 6.2% for preoperative beta blockers, 17.7% for patients with cardiac arrest, 27% for unplanned return to the operating room, and 94.7% for patients with all of these risk factors.ConclusionReadmissions after endovascular interventions for severe atherosclerotic disease can be used as a quality metric. Several factors place a patient at a high risk for readmission. Unplanned return to the operating room, cardiac arrest, preoperative beta blockers, location of disease, and preoperative symptoms are independent risk factors for hospital readmission. Unplanned return to the operating room is associated with 11.65-fold increase in the risk of hospital readmission.

Characteristics and therapeutic profile of TBI patients who underwent bilateral decompressive craniectomy: experience with 151 cases

“…USS, or unplanned reoperation, can be considered a type of severe operation-related adverse event [ 18 ], because if non-operative treatments were used successfully in patients, no USS would be needed. An unplanned return to the operating room is associated with an 11.65-fold increase in the risk of hospital readmission, and the quality of life of patients who undergo USS is worse [ 19 ]. The outcomes of breast cancer patients were found to be aggravated after USS [ 20 ], with similar reports in patients with acute spinal cord injury [ 21 ] and cervical spondylitis myelopathy [ 22 ].…”

Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency

“…Unfortunately, these guidelines do not take patients’ comorbidities and perioperative risks into account, but only the morphology of the lesion. [ 11 ] Graft infection, acute graft thrombosis, and aortoenteric fistula could be potentially fatal complications. [ 12 ] Other disadvantages include alternation of the normal anatomy, loss of collateral circulation, and loss of sexual function in males owing to pelvic autonomic nerve damage during surgery.…”