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 PS136. Predictors of 30-Day Readmission and Post-Discharge Mortality Following Lower Extremity Amputation in the ACS-NSQIP

Thomas Curran, Margriet Fokkema, Ruby C. Lo, Mark Wyers, Allen Hamdan, Elliot Chaikof, Marc L. Schermerhorn
Surgery, Beth Israel Deaconess Medical Center, Boston, MA.


OBJECTIVES: Post-operative readmission is associated with increased morbidity and mortality. We evaluated risk factors for readmission and post-discharge adverse events following lower extremity amputation in the ACS-NSQIP.

METHODS: All patients undergoing transmetatarsal (TMA), below-knee (BKA) or above-knee amputation (AKA) in the 2011 NSQIP were identified. Independent predictors of 30-day readmission were determined using multivariable logistic regression.

RESULTS: 3,438 patients underwent amputation (TMA: 12%; BKA: 50%; AKA: 38%). Readmission rate was 18%. Thirty-day mortality rate was 8.3% (TMA: 3%; BKA: 6%; AKA: 13%; p<0.01) with 44% of deaths occurring post-discharge. Overall complication rate was 47% (in-hospital: 41%; post-discharge: 9%). Post-discharge complications were readmitted in 71% of cases. Amputation level was not associated with increased complication rate or readmission rate. Independent predictors of readmission included OR takeback (OR: 7.0; 95% CI: 5.4-9.0), preoperative wound infection present at discharge (OR: 2.5; 95% CI: 1.5-4.1), dependent functional status (OR: 1.6; 95% CI: 1.2-2.2), history of lower extremity bypass (OR: 1.5; 95% CI: 1.1-1.9), preoperative dialysis (OR: 1.4; 95% CI: 1.1-1.7), pulmonary comorbidity (OR: 1.4; 95% CI: 1.0-1.5) and ASA≧4 (OR: 1.3; 95% CI: 1.0-1.5).

CONCLUSIONS: Post discharge morbidity, mortality and readmission are common following lower extremity amputation. Closer follow-up of high-risk patients, optimization of medical comorbidities and aggressive management of wound infection may decrease readmission and post discharge adverse events.

AUTHOR DISCLOSURES: E. Chaikof: Nothing to disclose; T. Curran: Nothing to disclose; M. Fokkema: Nothing to disclose; A. Hamdan: Endologix, Consulting fees or other remuneration (payment); R. C. Lo: Nothing to disclose; M. L. Schermerhorn: Endologix, Consulting fees or other remuneration (payment); M. Wyers: Endologix, Consulting fees or other remuneration (payment); Boston Scientific, Consulting fees or other remuneration (payment).
 
 
Complication
30-Day Rate
Post-Discharge Rate
Readmission Rate for Post-Discharge Event
Any Complication
47%
9%
71%
Any Wound Complication
9%
5%
69%
Sepsis
7%
2%
86%
Respiratory Failure
6%
1%
93%
UTI
4%
2%
62%
Pneumonia
4%
1%
90%
MI
2%
<1%
100%
 
 
 
Posted April 2013
 
 

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