M. J. Lin1, F. Baky2, B. Housley2, N. Kelly2, M. Chowdhury2, D. B. Tulman2, E. Pletcher1, J. D. Balshi1, S. P. Stawicki1, D. C. Evans2 1St. Luke’s University Health Network,Department Of Surgery,Bethlehem, PA, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA
Introduction: Vascular surgery patients constitute a population subset that has traditionally been considered "high-risk" for readmissions and mortality. Although various studies report factors associated with readmission or mortality in this population, data continue to be limited regarding the temporal risk profile for readmissions and mortality during the initial postoperative year. We set out to determine the relationship between various clinical determinants, hospital readmissions, and mortality in a sample of vascular surgical patients. We hypothesized that factors independently associated with hospital readmission and mortality will gravitate from traditional "short-term" indicators toward the more established "long-term" outcome determinants at 90, 180, and 360-day postoperative cut-off points.
Methods: Medical records of peripheral vascular surgery patients at two institutions (2008-2014) were retrospectively reviewed. Abstracted data included demographics, procedural characteristics, the American Society of Anesthesiologists (ASA) Physical Status, Goldman Criteria for postoperative cardiac complications, Charlson Comorbidity Index, morbidity, readmission data (30-day, 180-day, 360-day), and mortality (30-day, 180-day, 360-day). Univariate analyses were performed for both readmissions and mortality at each specified time point. Variables reaching statistical significance of p<0.20 were included in subsequent multivariate analyses for factors independently associated with readmission/mortality.
Results: A total of 450 patients were included in the current analysis. Most patients underwent either a bypass or endarterectomy revascularization (406/450) or non-catheter dialysis access procedure (44/450). There were 188 males and 262 females (mean age 61.1±13.8, 14% emergent procedures, median operative time 177 minutes). Median hospital length of stay (index admission) was 4 days (25%-75% IQR 2-8 days). Cumulative readmission rates at 30, 180, and 360 days were 12%, 27%, and 35%. For mortality, the corresponding figures were 3%, 7%, and 9%, respectively. Table 1 shows factors independently associated with 30-day, 180-day, and 360-day readmissions and mortality.
Conclusion: We noted important patterns in temporal variability regarding the risk of hospital readmission and mortality in peripheral vascular surgery patients. Previous readmissions, frailty/acuity indices, and cardiovascular morbidity were all independently associated with subsequent risk of readmission and mortality. The knowledge of temporal trends described herein may be helpful in guiding readmission reduction approaches — a consideration of increasing importance in the evolving paradigm of value-based healthcare.
