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 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)
Mean age [StdDev]
68.4 [11.2]
69.8 [11.6]
Diabetes Mellitus
614 (52.6)
210 (60.2)
Dialysis Dependence
103 (6.6)
54 (15.5)
Congestive Heart Failure
179 (15.3)
76 (21.8)
Tissue loss indication
575 (49.3)
223 (63.9)
SFA inflow
218 (18.7)
88 (25.2)
Mean LOS [StdDev]
10.6 [9.7]
12.2 [8.4]
Discharge to nursing facility
570 (48.9)
In-hospital Wound infection
34 (2.9)
66 (18.9)
Postoperative MI
28 (2.4)
19 (5.4)
In-hospital graft failure
46 (3.9)
36 (10.3)

Posted April 2012

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