Readmissions After Revascularization Procedures for Peripheral Arterial Disease

Secemsky, Eric A.; Schermerhorn, Marc L.; Carroll, Brett J.; Kennedy, Kevin F.; Shen, Changyu; Valsdottir, Linda R.; Landon, Bruce E.; Yeh, Robert W.

doi:10.7326/m17-1058

Cited by 49 publications

(31 citation statements)

References 16 publications

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“…However, major limitations of these procedures include restenosis and thrombosis. In fact, patency rates of limb revascularizations are estimated to be as low as 56% at 1 year and 30% at 5 years [53,54]. Readmission rates due to complications can also be as high as 17% [53,54].…”

Section: Discussionmentioning

confidence: 99%

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The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins

et al. 2020

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Peripheral artery disease (PAD) pathophysiology extends beyond hemodynamics to include other operating mechanisms, including endothelial dysfunction. Oxidative stress may be linked to endothelial dysfunction by reducing nitric oxide (NO) bioavailability. We aimed to investigate whether the NO system and its regulators are altered in the setting of PAD and to assess the relationship between NO bioavailability and oxidative stress. Sera from 35 patients with intermittent claudication (IC), 26 patients with critical limb ischemia (CLI), and 35 non-PAD controls were analyzed to determine levels of tetrahydrobiopterin (BH4), dihydrobiopterin (BH2), nitrate/nitrite (nitric oxides, or NOx), arginine, citrulline, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and the oxidative stress markers 8-Oxo-2′-deoxyguanosine (8-OHdG), 4-hydroxynonenal (4-HNE), advanced glycation end products (AGEs), and protein carbonyls. NOx was significantly lower in IC and CLI patients compared to controls in association with elevated oxidative stress, with the greatest NOx reductions observed in CLI. Compared with controls, IC and CLI patients had reduced BH4, elevated BH2, and a reduced BH4/BH2 ratio. SDMA, the arginine/SDMA ratio, and the arginine/ADMA ratio were significantly higher in CLI patients. The NO system and its regulators are significantly compromised in PAD. This dysregulation appears to be driven by increased oxidative stress and worsens as the disease progresses from claudication to CLI.

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Section: Discussionmentioning

confidence: 99%

“…In fact, patency rates of limb revascularizations are estimated to be as low as 56% at 1 year and 30% at 5 years [53,54]. Readmission rates due to complications can also be as high as 17% [53,54]. Thus, there is a great need for finding novel therapeutics and targets for intervention for PAD patients.…”

Section: Discussionmentioning

confidence: 99%

The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins

et al. 2020

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“…Next, we used hierarchical generalized linear models to estimate RSRRs 17. This approach accounts for within‐hospital correlation of the observed readmissions and assumes that, after adjusting for patient risk and sampling variability, the remaining heterogeneity is attributable to hospital quality 18, 19…”

Section: Methodsmentioning

confidence: 99%

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Secemsky

Rosenfield

Kennedy

et al. 2018

JAHA

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BackgroundVenous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden of 30‐day readmissions after such events has not been comprehensively assessed.Methods and ResultsWe analyzed adults ≥18 years of age with hospitalizations associated with acute VTE between January 1, 2010, and December 31, 2014, in the Nationwide Readmissions Database. International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐ CM) codes were used to identify hospitalizations associated with acute pulmonary embolism or deep vein thrombosis. The primary outcome was the rate of unplanned 30‐day readmission. Hierarchical logistic regression was used to calculate hospital‐specific 30‐day risk‐standardized readmission rates, a marker of healthcare quality. Among 1 176 335 hospitalizations with acute VTE, in‐hospital death occurred in 6.2%. VTE was associated with malignancy in 19.7%, recent surgery in 19.3%, recent trauma in 4.6%, hypercoagulability in 3.3%, and pregnancy in 1.0%. Among survivors to discharge, the 30‐day readmission rate was 17.5%, with no significant difference in rates across study years (17.4%–17.7%; P=0.10 for trend). Major predictors of readmission were malignancy (relative risk, 1.49, 95% confidence interval 1.47‐1.50), Medicaid insurance (relative risk, 1.48, 95% confidence interval 1.46‐1.50), and nonelective index admission (relative risk, 1.31, 95% confidence interval 1.29‐1.33). Top causes of readmission included sepsis (9.6%) and procedural complications (8.1%). Median rehospitalization costs were $9781.7 (interquartile range, $5430.7–$18 784.1), and 8.1% died during readmission. The interquartile range in risk‐standardized readmission rates was 16.6% to 18.3%, suggesting modest interhospital heterogeneity in readmission risk.ConclusionsNearly 1 in 5 patients with acute VTE were readmitted within 30 days. Predictors and causes of readmission were primarily related to patient characteristics and complications from comorbid conditions, whereas healthcare quality had a moderate impact on readmission risk.

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“…In addition, many researchers emphasize the poly factor of the process of atherogenesis, including the adverse effect of hemodynamic factors on the arterial wall, vasoactive substances, endo-and exogenous chemical compounds, dyslipoproteinemia of atherogenic nature, other disorders [7,8]. Special attention is paid to the role of early metabolic disorders of the arterial wall structure and the importance of lipoprotein oxidation in it [9,10].…”

Section: Introductionmentioning

confidence: 99%

Changes in the Hemostatic System Against the Background of Various Treatment Regimens in Patients With Atherosclerosis of Lower Extremities

Tverdovsky

Tutrin

Тарабрин

2019

EUREKA: Health Sciences

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About 2–3 % of the population and about 35–50 % of people over 65 years suffer from obliterating atherosclerosis of the main arteries of the lower extremities. There are many known factors that potentiate atherosclerosis. Some of them are referred to as leading, such as hyperlipoproteinemia or hypertension, others to concomitant contributing to the defeat of the arteries. According to J.S.A. Fuchs include hypertension, hypercholesterolemia and smoking as major risk factors for atherosclerosis. They are less affected by obesity, diabetes, hypertriglyceridemia, sedentary lifestyle, stress Objective of the study. The purpose of this study is to evaluate the functional status of the vascular – platelet, coagulation and fibrinolysis of the hemostasis system and their disorders using low – frequency piezoelectric thromboelastography (LPTEG) in patients with obliterating atherosclerosis of the lower extremities on the background of treatment. Materials and methods. The initial state of the hemostasis system was evaluated in 90 patients undergoing treatment for obliterating atherosclerosis of the lower extremities in the Odessa Regional Clinical Hospital and MD Odreks. All patients underwent surgery in the amount of femoral-popliteal autologous bypass grafting. Patients in the control (1st) group (45 patients) received analgesia during surgery and in the postoperative period based on epidural administration of bupivacaine, and their treatment regimen included enoxaparin 0.4 ml (40,000 anti-XA ME) 2 times a day subcutaneously into the anterolateral surface of the abdominal wall from the first postoperative day and pentoxifylline IV 200 mg twice a day for 7 days. Patients of the studied (2nd) group (45 patients) received analgesia during surgery and in the postoperative period on the basis of epidural administration of bupivacaine, also rivaroxaban 15 mg 2 times a day oraly on the first postoperative day was included in their treatment regimen. The dynamics of the state of the hemostatic system in both groups of patients with OA was evaluated using LPTEG in the first day before surgery and on the 3rd, 5th and 7th postoperative days. Results and conclusions. Before surgery and the start of treatment in patients with OA, against the background of activation of the vascular - platelet link of hemostasis, significant structural and chronometric hypercoagulation with increased thrombin generation and activation of blood fibrinolytic activity are noted. Against the background of treatment in the 1st group, platelet aggregation tends to normalize and there are significant differences compared with the indicators before treatment in the 1st group, the vascular-platelet and fibrinolytic systems did not reach normal values before 7 days, but showed a significant downward trend the degree of manifestation of their violations. Against the background of treatment of the 2nd group, significant changes were observed towards normalization in all components of the hemostatic system according to the LPTEG technique. The state of the coagulation unit of the hemostasis system in patients with OA on the 7th day of therapy does not significantly differ from the norm, it is possible to note significant shifts towards hypocoagulation within the normal range. The fibrinolytic system on the 7th day of treatment does not statistically differ from normal indicators, it has significant positive dynamics compared to 1 day. The second group revealed a statistically significant normalization of all indicators characterizing the blood coagulation potential of the blood and the aggregation ability of platelets, as well as the indicator that is responsible for changes in the fibrinolytic blood system.

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Readmissions After Revascularization Procedures for Peripheral Arterial Disease

Abstract: Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.

Cited by 49 publications

References 16 publications

The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins

The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Changes in the Hemostatic System Against the Background of Various Treatment Regimens in Patients With Atherosclerosis of Lower Extremities

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