Vascular Web Logo

SVS  SVS Foundation
A A A
VascularWeb

 RR4. Predictive Factors of 30-day Unplanned Readmission (URA) After Lower Extremity Bypass (LEB)

​James T. McPhee1, Neal R. Barshes2, Karen J. Ho1, Arin Madenci1, Charles K. Ozaki1, Louis L. Nguyen1, Michael Belkin1
1Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA; 2Michael E. DeBakey VA Medical Center, Houston, TX.

OBJECTIVES: Thirty-day URA after LEB is large cost-burden and a target for cost containment strategies. We undertook this study to identify factors associated with URA after LEB.

METHODS: This is a retrospective analysis from a prospective institutional registry. All LEBs for occlusive disease from 1/95-7/11 were included. The primary endpoint was 30-day URA.

RESULTS: Of 1,543 LEBs, 27 patients (1.7%) died in house and were excluded. Of 1,516 remaining LEBs, 84.5% were for CLI and 349 (23.0%) had 30-day URA. Univariate predictors of URA are shown in the Table. By multivariable analysis, pre-operative factors predictive of URA were: Dialysis (OR 1.73, p=0.004), Tissue loss (OR 1.62, p=0.0004), and CHF (OR 1.43, p<0.03). Postoperative predictors included: SFA inflow source (OR 1.38, p=0.016), wound infection (OR 8.30, p<0.0001) in-hospital graft failure (OR 3.20, p<0.0001) and MI (OR 1.96, p<0.04). Conduit type, LOS, and discharge disposition did not predict URA. URA independently predicted loss of assisted primary patency (HR 1.39, p=0.01) and long-term limb loss (HR 1.68, p=0.001).

CONCLUSIONS: Thirty-day URA is frequent following LEB (23%). It is essential to consider risk factors associated with URA for quality improvement and equitable resource allocation when disease-specific bundling strategies are being derived.

AUTHOR DISCLOSURES: N. R. Barshes, Nothing to disclose; M. Belkin, Nothing to disclose; K. J. Ho, Nothing to disclose; A. Madenci, Nothing to disclose; J. T. McPhee, Nothing to disclose; L. L. Nguyen, Nothing to disclose; C. K. Ozaki, Nothing to disclose.

 

Table: Univariate Predictors of Unplanned Re-admission

No Unplanned Readmission (%) n=1157 (77.0)
Unplanned Readmission (%) n=349 (23.0)
p-Value
Mean age [StdDev]
68.4 [11.2]
69.8 [11.6]
0.02
Diabetes Mellitus
614 (52.6)
210 (60.2)
0.014
Dialysis Dependence
103 (6.6)
54 (15.5)
0.006
Congestive Heart Failure
179 (15.3)
76 (21.8)
0.006
Tissue loss indication
575 (49.3)
223 (63.9)
<0.0001
SFA inflow
218 (18.7)
88 (25.2)
0.01
Mean LOS [StdDev]
10.6 [9.7]
12.2 [8.4]
<0.0001
Discharge to nursing facility
570 (48.9)
211(60.5)
0.0001
In-hospital Wound infection
34 (2.9)
66 (18.9)
<0.0001
Postoperative MI
28 (2.4)
19 (5.4)
0.007
In-hospital graft failure
46 (3.9)
36 (10.3)
<0.0001

Posted April 2012

Contact Us

Society for Vascular Surgery
633 North Saint Clair Street, 22nd Floor | Chicago, IL 60611
Phone: 312-334-2300 | 800-258-7188
Fax: 312-334-2320
Email: vascular@vascularsociety.org

Follow Us

YouTube

VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.