Unplanned return to operating room after lower extremity endovascular intervention is an independent predictor for hospital readmission

Objective

Hospital readmissions after surgical operations are preventable and are now counted as a quality metric. Patients with peripheral arterial disease often have several serious medical comorbidities. With advancements in endovascular technology and increasing comfort level of vascular surgeons, more and more patients with peripheral arterial disease are being treated with endovascular therapy. Most of these interventions are done as same-day operations. This study retrospectively reviewed the factors associated with hospital readmission after lower extremity endovascular interventions.

Methods

This study used the 2013 endovascular repair-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery Program User Files. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity endovascular surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission ≤30 days after surgery.

Results

During 2013, 1096 patients (61% men, 39% women) underwent lower extremity endovascular interventions. Indications for operations included claudication (40%), critical limb ischemia with rest pain (19%), critical limb ischemia with tissue loss (35%), and others (6%) Among these patients, 147 (13.4%) were readmitted to the hospital ≤30 days after surgery, and ～46% of all readmissions were ≤2 weeks after the discharge The following factors had significant associations with readmission: smoking (odds ratio [OR], 0.52, 95% confidence interval [CI], 0.3-0.9), noninsulin-dependent diabetes mellitus (OR, 1.65; 95% CI, 0.9-3.2), dyspnea (OR, 1.9; 95% CI, 1-3.7), insulin-dependent diabetes mellitus (OR, 2.1; 95% CI, 1.2-3.6), body mass index >30 kg/m² (OR, 2.5; 95% CI, 1.3-5.1), dependent functional status (OR, 2.6; 95% CI, 1.4-4.8), emergent surgery (OR, 4.3; 95% CI, 1.9-9.6), and unplanned return to the operating room (OR, 8.3; 95% CI, 4.7-14.7).

Conclusions

Readmission after lower extremity endovascular intervention is a serious complication. Various factors place a patient at a high risk for readmission. High body mass index, unplanned return to the operating room, insulin-dependent diabetes mellitus, noninsulin-dependent diabetes mellitus, nonsmoking status, dyspnea, dependent functional status, and emergency operation are independent risk factors for hospital readmission. Return to operating room is associated with an 8.3-fold increase in hospital readmission.