Richard S. Saunders1, Sara Fernandes-Taylor1, Marquita R. Decker1, Qianqian Zhao1, Jeffrey A. Havlena1, Travis L. Engelbert1, David Y. Greenblatt2, Amy J. Kind1, Emily R. Winslow1, Caprice C. Greenberg1, Maureen A. Smith1, K. Craig Kent1
1University of Wisconsin, Madison, WI; 2University of California San Francisco, San Francisco, CA.
OBJECTIVES: Medicare will penalize hospitals for vascular surgery readmissions starting in 2015. However, some patients are readmitted to a non-index hospital, leaving clinical decisions out of the control of the primary surgeon. This study characterizes readmission to index vs. non-index facilities after AAA repair.
METHODS: We examined bivariate and multivariate logistic associations with robust variance estimates for a 5% random national sample of Medicare beneficiaries who underwent AAA repair from 2005-2009 and were readmitted within 30 days of index discharge.
RESULTS: Eight hundred eighty-four patients undergoing AAA repair (open or endovascular) were readmitted within 30 days. 70.7% returned to the index facility and 29.3% returned to a non-index facility. Patients from rural areas were more likely to return to a non-index hospital than urban residents (43.0% vs. 23.3%, p<0.001). For patients treated at an academic institution (medical school) the incidence of readmission to a non-index hospital was increased (33.7% academic vs. 27.1%, p<0.002). Emergent readmission was more frequent to non-index hospitals (71.4%, vs. 63.7% index, p<0.027). These results persisted in multivariate analysis. No other factors including comorbidities, demographics, index procedure complications and initial discharge location were associated with readmission to an index vs. non-index hospital. Interestingly, average total costs at 30 and 60-days following initial discharge were greater when patients were readmitted to an index vs. non-index facility. No mortality difference was observed.
CONCLUSIONS: Readmission to non-index facility after AAA repair is common (29%) and more frequent than for the overall Medicare population (22%). Patients from rural areas and those treated at academic medical centers are more likely to return to their local hospitals. Quality improvement efforts to reduce readmissions following AAA repair will need to account for those patients who are treated outside the purview of the primary surgeon's care.
AUTHOR DISCLOSURES: M. R. Decker: Nothing to disclose; T. L. Engelbert: Nothing to disclose; S. Fernandes-Taylor: Nothing to disclose; C. C. Greenberg: Nothing to disclose; D. Y. Greenblatt: Nothing to disclose; J. A. Havlena: Nothing to disclose; K. Kent: Nothing to disclose; A. J. Kind: Nothing to disclose; R. S. Saunders: Nothing to disclose; M. A. Smith: Nothing to disclose; E. R. Winslow: Nothing to disclose; Q. Zhao: Nothing to disclose.
Posted April 2013