Benjamin S. Brooke1, David H. Stone1, Jack L. Cronenwett1, Randall R. De Martino1, Andrew W. Hoel1, Richard J. Powell1, Lori L. Travis3, David C. Goodman2, Philip P. Goodney1
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH; 3Maine Medical Center, Portland, ME.
OBJECTIVES: Readmission after vascular surgery is a quality measure that will soon affect reimbursement, despite limited understanding of risk factors. This study evaluates whether regional variation in primary care utilization is associated with readmission following thoracic aortic aneurysm (TAA) repair.
METHODS: Using Medicare claims linked to primary care utilization data from the Dartmouth Atlas, we identified 7,441 patients who underwent open TAA repair from 2003-07 in nationwide hospital referral regions (HRRs). We divided HRRs into tertiles based on the annual rate of primary care visits, and used logistic regression & propensity score matching to evaluate 30-day readmission rates.
RESULTS: There were 1,592 (21%) patients readmitted within 30-days after open TAA repair, on average 10 days following discharge. Readmission was more likely in patients with a Charlson score >2, renal complications, & length of stay >9 days (p<0.01). Readmission was less likely to occur in HRRs with high vs. low rates of primary care utilization (OR: 0.78; p<0.01). In the propensity-matched cohorts, there was no difference in readmission rates following TAA repair among patients at low or moderate risk for readmission, but patients at high risk were significantly less likely to be readmitted (21% vs. 33%; p<0.01) when TAA repair was undertaken in HRRs with high primary care utilization (Figure).
CONCLUSIONS: Readmission rates following TAA repair in high-risk patients were significantly lower in regions with high primary care utilization. These results highlight the importance of primary care coordination after complex vascular surgery.
AUTHOR DISCLOSURES: B. S. Brooke, Nothing to disclose; J. L. Cronenwett, Nothing to disclose; R. R. De Martino, Nothing to disclose; D. C. Goodman, Nothing to disclose; P. P. Goodney, Nothing to disclose; A. W. Hoel, Nothing to disclose; R. J. Powell, Nothing to disclose; D. H. Stone, Nothing to disclose; L. L. Travis, Nothing to disclose.
Posted April 2012