Hospital readmission rates high after revascularization for PAD
More than 1 in 6 patients undergoing peripheral revascularization for peripheral artery disease were readmitted to the hospital within 30 days of the procedure, according to new data published in Annals of Internal Medicine.
These unplanned readmissions were also associated with increased mortality and high costs.
A team of researchers analyzed data from the Nationwide Readmissions Database on 61,969 unweighted hospitalizations for patients with PAD who underwent peripheral arterial revascularization and survived to discharge.
At 30 days, the unplanned readmission rate was 17.6%. More than one-quarter (28%) of unplanned readmissions were attributable to procedure-related complications. Other common causes included sepsis (8.3%), diabetes complications (7.5%) and gangrene (5.1%).
At 7 days, procedural complications were still the most common cause of unplanned readmissions (25.4%), but they were responsible for more readmissions among patients who underwent surgical revascularization compared with endovascular revascularization (40.5% vs. 16.3%), according to the researchers.
Of patients who were readmitted to the hospital at 30 days, 8.2% had subsequent peripheral arterial revascularization, 11.7% had lower-extremity amputation, 1.1% had both and 4.6% died during readmission.
The cost of readmission was high, with the median nationally weighted cost totaling $11,013. Costs according to procedure type were $11,567 for endovascular procedures, $10,541 for surgical procedures and $11,796 for hybrid procedures. In total, the nationally weighted cost of all readmissions was $401,112,036, according to the data.
The researchers also calculated hospital-specific 30-day risk-standardized readmission rates, which ranged from 10% to 27.3% with a median of 17.5%.
In a subset of patients with chronic limb ischemia, the 30-day readmission rate was 21.3%, with procedural complications being the primary cause (25.6%). During readmission, 25% underwent subsequent peripheral arterial revascularization, lower extremity amputation or both, and 5.2% died in the hospital. At $12,394, the median nationally weight cost of readmission was also slightly higher for this subset of patients.
Patients who were readmitted to the hospital were more often older, women, insured by Medicare or Medicaid, and lived in lower-income areas and counties with larger populations. They also tended to have more comorbidities, including chronic limb ischemia, obesity, hypertension, congestive HF, diabetes and renal disease. Additionally, readmissions were more common among patients who underwent nonelective index procedures (66.7% vs. 47.2%). They also had longer index hospitalizations (median, 7 vs. 5 days) and were more routinely discharged to short-term, subacute nursing or intermediate care facilities (34.2% vs. 21.7%). Index hospitalizations were costly among these patients as well (median, $26,029 vs. $20,264). In-hospital adverse events, particularly major bleeding acute MI, acute kidney injury and sepsis, during the index hospitalization also occurred more frequently in patients who were readmitted to the hospital at 30 days.
Overall, these results indicate that unplanned readmissions in patients undergoing revascularization for PAD were mostly attributable to procedure- and patient-related factors, the researchers noted.
“As such, strategies to reduce the need for readmission should prioritize improving postdischarge patient care for these high-risk patients,” Eric A. Secemsky, MD, MSc, fellow at Massachusetts General Hospital, and colleagues wrote. – by Melissa Foster
Disclosures: One author reports he receives personal fees from Abbott, Cook and Philips. Another author reports he receives nonfinancial support from the City of Newton, Massachusetts, and Myers-JDC Brookdale Institute, and personal fees from the American Board of Internal Medicine, Evidera, Freedman Healthcare Consulting, RTI International and UpToDate. All other authors report no relevant financial disclosures.