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Causes and Implications of Readmission After Abdominal Aortic Aneurysm (AAA) Repair
David Yu Greenblatt*, Caprice C. Greenberg*, Amy J. Kind*, Matthew W. Mell*, Jeff Havlena*, Matthew T. Nelson*, Maureen A. Smith*, K. Craig Kent
University of Wisconsin, Madison, WI

OBJECTIVE: In 2014 CMS will eliminate reimbursement for 30-day readmissions after vascular procedures. An understanding of the frequency, predictors, and causes of readmission is urgently needed.
METHODS: We analyzed elective AAA repairs over a two-year period from a 5% national sample of Medicare beneficiaries.
RESULTS: 2481 patients underwent AAA repair--1502 endovascular (EVAR) and 979 open. Surprisingly, 30-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). While wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed--e.g., bowel obstruction following open repair and graft complication after EVAR (Table 1). In multivariate analyses, preoperative comorbidities had little effect on readmission; however, postoperative factors including serious complications leading to prolonged length of stay and discharge destination other than home had a profound influence on probability of readmission (Table 2). The one-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (p<0.001).
CONCLUSIONS: Early readmission is common after AAA repair. Postoperative events rather than comorbidities predict readmission, suggesting that interventions designed to improve in-hospital outcomes can also impact quality and cost post-discharge. Such interventions become even more crucial given the increased one-year mortality and pending financial implications of readmission.
Table 1. Readmission diagnoses after EVAR and open AAA repair
EVAR Readmission Diagnosis
(n=200 Readmissions)
Open Readmission Diagnosis
(n=125 Readmissions)
Rank #%%
1Wound Complication15.5Wound Complication17.6
2Respiratory Complication11.5Bowel Obstruction13.6
3AAA/Graft Complication10.0Respiratory Complication12.0
4Congestive Heart Failure8.5Sepsis10.4
5Sepsis6.5Myocardial Infarction5.6

Table 2. Predictors of 30-day readmission after AAA repair (* p<0.05)
VariableAdjusted OR
(95% CI)
Congestive Heart Failure1.39 (1.03-1.87)
Renal Failure1.30 (0.89-1.90)
Diabetes1.25 (0.95-1.64)
Chronic Pulmonary Disease1.20 (0.94-1.53)
Complication Requiring Reintervention1.83 (1.09-3.08) *
Prolonged Length of Stay (>7d)2.11 (1.58-2.82) *
Discharge Destination (vs. Home)
- Home with Home Nursing1.82 (1.31-2.52) *
- Skilled Nursing Facility3.44 (2.36-5.02) *
- Other Facility2.44 (1.49-4.00) *

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