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