Reasons for Readmission After Carotid Endarterectomy

Rambachan, Aksharananda; Smith, Timothy R.; Saha, Sujata; Eskandari, Mark K.; Bendok, Bernard R.; Kim, John Y.S.

doi:10.1016/j.wneu.2013.08.020

Cited by 29 publications

(48 citation statements)

References 41 publications

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“…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%

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: Discussionmentioning

confidence: 99%

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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“…Procedure-specific studies have found mixed results regarding the impact of sex on readmissions. 5,6,16,17 Another commonly described risk factor is a measure of overall health, based on either ASA class or Charlson Comorbidity Index. 5,17 The proposed risk score does not include a global assessment of health, and the inclusion of individual risk factors including pulmonary, cardiac, and renal comorbidities had the best performance.…”

Section: Discussionmentioning

confidence: 99%

Risk score for unplanned vascular readmissions

Iannuzzi

Chandra

Kelly

et al. 2014

Journal of Vascular Surgery

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“…56 This data source has been previously used to evaluate patients undergoing neurosurgical intervention, 7,9,11,13,24,28,33,[47][48][49]52,53 including craniotomy for tumor. [1][2][3]10,14,29,54 The NSQIP database has been exempted as not human subject research by our institutional review board.…”

Section: Data Sourcementioning

confidence: 99%

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Devine

et al. 2015

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OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ≤ 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission.

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Reasons for Readmission After Carotid Endarterectomy

Cited by 29 publications

References 41 publications

Readmissions After Carotid Artery Revascularization in the Medicare Population

Readmissions After Carotid Artery Revascularization in the Medicare Population

Risk score for unplanned vascular readmissions

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

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