Short- and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected

Krafcik, Brianna M.; Komshian, Sevan; Lu, Kimberly; Roberts, Lauren; Farber, Alik; Kalish, Jeffrey; Rybin, Denis; Siracuse, Jeffrey J.

doi:10.1016/j.jvs.2017.07.120

Cited by 22 publications

(15 citation statements)

References 19 publications

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“…11 The individual complications rates in our study were also similar to those reported in the NSQIP, including MALE (2.8% vs 3.2%) and MACE (1.0% vs 1.7%). These complication rates were also consistent across multiple other databases, including analyses of institutional databases 18,19 and the Vascular Quality Initiative. 20 It is encouraging that the major complication rate associated with elective LEB has been consistently <10%.…”

Section: Discussionsupporting

confidence: 65%

Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

Sorber

Alshaikh

Nejim

et al. 2021

Journal of Vascular Surgery

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Objective: Increasing evidence has shown that the risks associated with surgical revascularization for intermittent claudication outweigh the benefits. The aim of our study was to quantify the cost of care associated with perioperative complications after elective lower extremity bypass (LEB) in patients presenting with intermittent claudication.Methods: All patients undergoing first-time LEB for claudication in the Healthcare Database (2009)(2010)(2011)(2012)(2013)(2014)(2015) were included. The primary outcome was in-hospital postoperative complications, including major adverse limb events (MALE), major adverse cardiac events (MACE), acute kidney injury, and wound complications. The overall crude hospital costs are reported, and a generalized linear model with log link and inverse Gaussian distribution was used to calculate the predicted hospital costs for specific complications.

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Section: Discussionsupporting

confidence: 65%

Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

Sorber

Alshaikh

Nejim

et al. 2021

Journal of Vascular Surgery

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“…Also, patients who died during follow-up were not included in the analysis as demonstrated in previous studies that analyzed readmission for resource utilization. 5,21 Outcome variables collected at 30, 90, and 180 days were survival, readmission reasons, and reinterventions. Readmission reasons after the index TEVAR were identified by the primary ICD-9-CM diagnosis code and categorized by similarity.…”

Section: Methodsmentioning

confidence: 99%

Readmissions after thoracic endovascular aortic repair

Kalesan

Cheng

Farber

et al. 2018

Journal of Vascular Surgery

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A large portion of patients treated with TEVAR were readmitted most commonly for heart-related reasons at 30 days and aorta-related reasons at 90 and 180 days. TEVAR performed to treat initial aortic rupture and greater DRG severity grade were independently associated with an index readmission at 30, 90, and 180 days. Urgent/emergent TEVAR was independently associated with an index readmission at 90 and 180 days. These factors are important to consider in using readmissions as a quality measure.

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“…Previous studies have shown varied readmission rates for vascular surgery patients. [16][17][18][19][20][23][24][25][26] Medicare reports an average 30-day readmission rate of 24%, while an overall NSQIP analysis evaluating 86 238 vascular surgery patients found a 30-day readmission rate of 10%. 23,25 Damrauer et al specifically examined 30-day readmissions after LEB and found a readmission rate of 20%.…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremity bypass (LEB) has previously been shown to be very resource intensive with longer than expected hospital stays and higher readmission rates within the surgical global period. 19,20 It is unclear how hypoalbuminemia affects these metrics in the long term such as readmission and mortality within the 90-day surgical global period.…”

Section: Introductionmentioning

confidence: 99%

Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass

Westfall

Cheng

Farber

et al. 2019

Vasc Endovascular Surg

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Introduction: Preoperative hypoalbuminemia is associated with poor outcomes across many surgical fields. However, the effects on outcomes after lower extremity bypass (LEB), particularly over the 90-day global surgical period, are unclear. Our goal was to analyze the effect of hypoalbuminemia within 90 days after LE bypass. Methods: We performed a single-center retrospective review of all infrainguinal LEBs from 2007 to 2017. Patients were categorized into 3 preoperative albumin groups: severe hypoalbuminemia (SH; albumin ≤2.8g/dL), mild–moderate hypoalbuminemia (MH; albumin >2.8-3.5g/dL), and normal albumin (albumin >3.5g/dL). Patient and procedural details were recorded. Outcomes analyzed included wound infection, myocardial infarction (MI), pulmonary complications, early graft occlusion (≤30 days), mortality, and emergency department (ED) presentation and readmissions within 30 and 90 days. Multivariable analysis was performed. Results: We identified 313 patients undergoing LEB—45 (14.4%) with SH, 133 (42.5%) with MH, and 135 (43.1%) with normal albumin. Overall, the mean age was 65.7 years, and 63.3% were male. The SH group more frequently had tissue loss, diabetes, hypertension, end-stage renal disease, preoperative hematocrit <30%, and patients admitted preoperatively (all P < .05). There were no significant differences in wound complications, MI, pulmonary complications, early graft occlusion, 30-day or 90-day mortality, and 30-day ED presentation. Severe hypoalbuminemia compared to MH and normal albumin, respectively, had significantly higher rates of 30-day readmission (40% vs 30.8% vs 17.8%, P = .005), 90-day ED presentation (55.6% vs 33.8% vs 29.6%, P = .006), and 90-day readmission (66.7% vs 48.9% vs 35.6%, P = .001). Multivariable analysis showed that SH was independently associated with 90-day ED presentation (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.23-6.36, P = .014) and 90-day readmission (OR: 2.63, 95% CI: 1.21-5.71, P = .015). Conclusion: Our study suggests that patients with SH undergoing LEB had similar perioperative complication rates compared to normal albumin and MH groups, and SH was independently associated with 90-day ED presentation and readmission. Further studies are needed to assess other factors associated with ED visits and readmission.

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Short- and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected

Cited by 22 publications

References 19 publications

Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

Readmissions after thoracic endovascular aortic repair

Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass

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