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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 # | | % | | % | 1 | Wound Complication | 15.5 | Wound Complication | 17.6 | 2 | Respiratory Complication | 11.5 | Bowel Obstruction | 13.6 | 3 | AAA/Graft Complication | 10.0 | Respiratory Complication | 12.0 | 4 | Congestive Heart Failure | 8.5 | Sepsis | 10.4 | 5 | Sepsis | 6.5 | Myocardial Infarction | 5.6 | Table 2. Predictors of 30-day readmission after AAA repair (* p<0.05)Variable | Adjusted OR (95% CI) | Congestive Heart Failure | 1.39 (1.03-1.87) | Renal Failure | 1.30 (0.89-1.90) | Diabetes | 1.25 (0.95-1.64) | Chronic Pulmonary Disease | 1.20 (0.94-1.53) | Complication Requiring Reintervention | 1.83 (1.09-3.08) * | Prolonged Length of Stay (>7d) | 2.11 (1.58-2.82) * | Discharge Destination (vs. Home) | | - Home with Home Nursing | 1.82 (1.31-2.52) * | - Skilled Nursing Facility | 3.44 (2.36-5.02) * | - Other Facility | 2.44 (1.49-4.00) * |
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