H. Khoury1, Y. Sanaiha1, S. Rudasill1, H. Xing1, A. Mardock1, R. Jaman2, H. Gelabert2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA
Introduction: While short-term outcomes of endovascular and open surgical revascularization in patients with peripheral artery disease have been previously reported, 30-day readmission and resource use following these procedures remain unknown.
Methods: We used the 2010-2015 Nationwide Readmissions Database and the International Classification of Diseases, Ninth Edition to identify patients with peripheral artery disease undergoing either endovascular or open infra-inguinal bypass revascularization. Student’s t-test and chi-squared test were used to compare baseline continuous and categorical variables, respectively. Multivariable logistic regression was used to evaluate the independent association between the two procedures and readmission, index complications, and mortality.
Results: Of an estimated 782,593 patients diagnosed with peripheral artery disease (PAD), 352,587 and 304,928 underwent endovascular and open surgery revascularization, respectively. Compared to patients who underwent open revascularization, endovascular patients were more commonly female (44.8 vs. 36.7%, P<0.001), and older (69.4 vs. 67.2 years, P<0.001). Moreover, they had a higher Elixhauser Comorbidity Index (4.3 vs. 3.8, P<0.001) and cost of index hospitalization ($25,288 vs. 21,949, P<0.001), in addition to experiencing higher rates of 30-day readmission (16.0 vs. 13.7%, P<0.001), in-hospital complications (21.1 vs. 19.0%, P<0.001), and in-hospital mortality (2.1 vs. 1.7%, P<0.001). 30-day readmission for endovascular and open revascularization increased the overall hospitalization cost by an estimate of $16,841 and $16,235, respectively. In contrast, the risk-adjusted multivariable analysis found open revascularization to be independently associated with increased odds of 30-day readmission (OR, 1.11; 95% CI 1.08 – 1.14), index complications (OR, 1.16; 95% CI 1.13 – 1.19) and mortality (OR, 1.26; 95% CI 1.16 – 1.35), compared to those who underwent endovascular revascularization. Trend analysis revealed a decreasing annual incidence of PAD, endovascular and open revascularization procedures (Figure).
Conclusion: Despite lower rates of adverse events compared to endovascular, open infra-inguinal surgical revascularization is independently associated with increased risk of short-term readmission, complications and mortality. Aside from anatomic factors, these findings should be considered in the selection of appropriate surgical therapy for arterial occlusive disease of the lower extremities.
