Unplanned return to operating room after endovascular repair of abdominal aortic aneurysm (EVAR) is associated with increased risk of hospital readmission

Aziz, Faisal; Ferranti, Katelynn; Lehman, Erik

doi:10.1177/1708538117721622

Cited by 3 publications

(3 citation statements)

References 22 publications

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“… 27 Residual aortic disease, complications with grafts, and preexisting cardiovascular comorbidities were found to be the main drivers of readmission after TBAD repair. Additionally, Aziz and colleagues 14 showed that the most common cause of readmission after the endovascular repair of abdominal aortic aneurysm was infection, including superficial and deep surgical site infection. As the third most common reason for readmission in our overall cohort, infection is a preventable complication that should be addressed through targeted strategies to reduce readmission and associated costs during the first postoperative year.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Independent predictors of readmission have been identified across numerous aortic surgical procedures, including abdominal aortic aneurysm repair and Stanford Type A aortic dissection. 13 , 14 Although several studies have investigated outcomes and short-term readmission rates after aortic dissection repair, 15 , 16 risk factors that lead to readmission during the first postoperative year remain unknown. Using a large nationwide database, we analyzed the features of patients with TBAD who undergo TEVAR or OSR and determined the rates and risk factors of readmission during the first postoperative year.…”

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confidence: 99%

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Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

et al. 2022

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

et al. 2022

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“…This database has been previously utilised in orthopaedic and other surgical publications. 8,19,20 Institutional Review Board deemed this study exempt as the data analysed is from a public source.…”

Section: Data Sourcementioning

confidence: 99%

The effect of body mass index on 30-day complications after total hip arthroplasty

et al. 2019

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Background: Evaluating body mass index (BMI) as a continuous variable eliminates the potential pitfalls of only considering BMI as a binary or categorical variable, as most studies do when correlating BMI and total hip arthroplasty (THA) outcomes. Therefore, the objective of this study was to correlate the effect of continuous BMI on 30-day complications post-THA. Specifically, we correlated BMI to: (1) 30-day readmissions and reoperations; (2) medical complications; and (3) surgical complications in: (a) normal-weight; (b) over-weight; (c) obese; and (d) morbidly obese patients. Methods: Using the NSQIP database, 93,598 primary THAs were identified. 30-day rates of readmissions, reoperations, and medical/surgical complications as well as patient BMI data were extrapolated. A comparative analysis using univariate, multivariate, and spline regression models adjusting for demographics and comorbidities were created to study the continuous effect of BMI on different outcomes. Results: Readmission ( p < 0.001), reoperation ( p = 0.007), superficial infection ( p = 0.003), prosthetic joint infection ( p < 0.001), and sepsis ( p = 0.026) had a J-shaped relationship with BMI, with the lowest rates seen in patients with BMI around 28 kg/m2. The risks of mortality ( p = 0.007) and transfusion ( p < 0.001) had a reverse J-shaped relationship, with the risk steadily decreasing for BMIs in the normal weight and overweight range, and then flattening afterwards. Conclusion: This data proposes a multifactorial effect of BMI on post-THA complications. Considering BMI as a continuous variable allows for a better assessment when considering the interplay between modifiable risk factors, such as smoking or alcohol use, as well as multiple comorbidities.

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

Pooshpas

Lehman

Aziz

2018

Cureus

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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.

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Unplanned return to operating room after endovascular repair of abdominal aortic aneurysm (EVAR) is associated with increased risk of hospital readmission

Cited by 3 publications

References 22 publications

Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

The effect of body mass index on 30-day complications after total hip arthroplasty

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

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