Unplanned 30-day readmissions after endovascular aneurysm repair: An analysis using the Nationwide Readmissions Database. J Vasc Surg 2019 Nov;70(5):1603-1611
Date
05/31/2019Pubmed ID
31147138DOI
10.1016/j.jvs.2019.02.034Scopus ID
2-s2.0-85066110374 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
BACKGROUND: Endovascular aneurysm repair (EVAR) is the preferred method for addressing abdominal aortic aneurysms (AAAs), with proven reduction in perioperative morbidity and mortality. There are, however limited data examining the readmissions after EVAR that are associated with increased patient morbidity and cost. As EVAR use continues its dominance in the management of AAAs, it becomes imperative to identify and mitigate risk factors associated with unplanned hospital readmissions.
METHODS: The Nationwide Readmissions Database (NRD) was queried for all 30-day readmissions after an index EVAR procedure from 2012 to 2014. Preoperative patient demographics, hospital characteristics, readmission diagnosis, and costs were compared between those who were and were not readmitted within 30 days of the index operation. Multivariable logistic regression was used to identify potential risk factors associated with unplanned readmissions within 30 days.
RESULTS: We identified 120,646 patients who underwent an EVAR from 2012 to 2014 in the United States. The overall unplanned readmission rate during this period was 11.6% (n = 14,073) within 30 days of the index EVAR procedure. The readmission rate was the highest in 2012, with a rate of 12.3% (P = .02). Multivariate regression analysis showed that EVAR readmissions were significantly higher in patients who were of younger age (18 to 49 years) compared with other age groups (odds ratio [OR], 1.9-2.17; P < .001), female sex (OR, 1.367; P < .001), had Medicare (OR, 1.39) or Medicaid (OR, 1.25) insurance, or a combination of these. Underlying patient comorbidities significantly associated with readmissions included congestive heart failure (OR, 2.4), peripheral vascular disease (OR, 1.1), chronic pulmonary disease (OR, 1.2), cancer with no metastasis (OR, 1.5), metastatic cancer (OR, 2.2), renal failure (OR, 1.8), and diabetes (OR, 1.5).
CONCLUSIONS: The trend in 30-day readmission rates after EVAR has decreased slightly since 2012, but overall rates are at 11.6%, which is not insubstantial. Patient factors strongly associated with hospital readmission were younger age and patient comorbidities, including congestive heart failure, concurrent cancer diagnosis, renal failure, and diabetes.
Author List
Dua A, Rothenberg KA, Wohlaer M, Rossi PJ, Lewis BD, Brown KR, Seabrook GR, Lee CJAuthors
Brian D. Lewis MD Professor in the Surgery department at Medical College of WisconsinPeter J. Rossi MD Chief, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
Blood Vessel Prosthesis Implantation
Comorbidity
Databases, Factual
Diabetes Mellitus
Endovascular Procedures
Female
Heart Failure
Humans
Male
Middle Aged
Neoplasms
Patient Readmission
Renal Insufficiency
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
United States
Young Adult