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Home > Vascular Annual Meeting > PP44. Determinants of Hospital Disposition After Lower...

PP44. Determinants of Hospital Disposition After Lower Extremity Bypass Surgery

Soma M. Brahmanandam1, Louis M. Messina1, Michael Belkin2, Michael S. Conte3, Louis L. Nguyen2
1University of Massachusetts, Worcester, MA; 2Brigham & Women's Hospital, Boston, MA; 3University of California San Francisco, San Francisco, CA

OBJECTIVES: Analyses of resource utilization (RU) after lower extremity bypass (LEB) are primarily based on the index hospitalization. This calculation, however, does not account for additional health care services that are often needed upon discharge. To better understand patterns of RU in LEB patients, we analyzed predictors of disposition between claudicants and patients with critical limb ischemia (CLI). We hypothesized that demographic, socioeconomic, and hospital factors, independent of clinical factors, can impact the need for services on discharge after LEB.

METHODS: The 2005 Nationwide Inpatient Sample was analyzed for patients who underwent LEB for claudication or CLI. Outcomes of interest were discharge to home (routine) vs. discharge with additional services (DAC). Variables tested as predictors of disposition in multivariable logistic models, included demographic (age, gender, race), economic (income level, insurance), clinical [comorbidities, admission status, amputations and debridements, length of hospitalization (LOS), severity of peripheral vascular disease (PVD)], and hospital characteristics (location and hospital ownership).

RESULTS: Among 5,868 LEB patients, 2,379 (40.5%) were claudicants and 3,489 (59.5%) had CLI. Among claudicants, 497 (20.9%) required DAC whereas, 2,003 (57.4%) CLI patients required DAC (p<0.0001). CLI patients had greater utilization of all types of DAC, such as home health care and transfer to rehabilitation facility being the most common. Multivariable analysis showed that after controlling for PVD severity and comorbidities, independent predictors of DAC among claudicants were older age, female gender, care at a private hospital, and longer LOS. Among CLI patients, significant predictors of DAC were similar with the addition of African-American race, highest-income quartile, and receiving an amputation or debridement.

CONCLUSIONS: Postoperative care of LEB patients is not complete at discharge, but often requires DAC. The differential use of these services between claudicants and CLI patients shown in our study helps us understand patterns of RU among LEB patients. Furthermore, understanding predictors of DAC can ultimately help health care providers anticipate and prepare for patients who will likely require these services.

AUTHOR DISCLOSURES: S.M. Brahmanandam, None; L.M. Messina, None; M. Belkin, None; M.S. Conte, None; L.L. Nguyen, None.