Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Abstract

BackgroundThe significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.Methods and ResultsThis was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow‐up of 381 days (interquartile range [IQR], 115–718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33–190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan–Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5–6.5; P=0.002).ConclusionsMost readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.

A nationwide analysis of 30-day readmissions related to critical limb ischemia

“…Further, CLI is the most common cause of readmission in these patients. 6,7,15 The study has several important findings. The overall 30-day readmission rate for a diagnosis of CLI was 5%.…”

“…This study evaluates the national 30-day CLI-related readmission rates for patients admitted initially with a primary discharge diagnosis of CLI. 7 We have focused on readmissions specifically due to CLI rather than all-cause readmissions as we wished to understand the impact of current management practices on outcomes. Further, CLI is the most common cause of readmission in these patients.…”

“…Evidence from a single center and institutional registries indicates a high readmission rate in these patients. [6][7][8] However, these studies have focused on all-cause readmissions and not specifically looked at readmissions secondary to CLI/limb events. Unlike many other diseases (such as congestive heart failure or acute myocardial infarction) and procedures (such as coronary interventions) where there is a wealth of data on acceptable readmission rates and predictors of readmission, these metrics are not well known for CLI.…”

Vasculogenic Chronic Ulcer: Tissue Regeneration with an Innovative Dermal Substitute

“…Moreover, Reed et al [42,43] in a retrospective study of 179 patients with CLI and tissue loss, demonstrated through the Kaplan-Meyer statistical analysis, that the probability of major adverse events (MALE-major amputation, surgical endarterectomy, or bypass) was higher in patients with trophic lesions that did not heal within four months of revascularization (log-rank P < 0.0001) compared to those with healed lesions. Patients with non-healing lesions also had a higher rate of amputation (HR, 9.0, 95% CI, 2.6–31.1; P = 0.0004), while patients with lesions healed in three months showed the lowest amputation rate (log-rank, P = 0.04).…”

“…Patients with non-healing lesions also had a higher rate of amputation (HR, 9.0, 95% CI, 2.6–31.1; P = 0.0004), while patients with lesions healed in three months showed the lowest amputation rate (log-rank, P = 0.04). The same authors have also published a retrospective study of 252 patients treated with endovascular CLI procedures and are re-hospitalized after 30 to 180 days for unhealed trophic lesions [43]. From this data it is clear that chronic wounds, both arterial and mixed arterial/venous, represent a strong unmet medical need so far.…”