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 PS96. Predictors of 30-Day Readmission and Analysis of Complications After Lower Extremity Bypass Using NSQIP

​Jennifer Zhang, Thomas Curran, Margriet Fokkema, Ruby C. Lo, Mark Wyers, Alan Hamdan, Elliot Chaikof, Marc L. Schermerhorn
Surgery, BIDMC, Boston, MA.


OBJECTIVES: Readmission is associated with high mortality, morbidity and cost. We used the NSQIP to determine predictors of 30-day readmission rates.

METHODS: We identified all patients who received lower extremity (LE) bypass in the 2011 ACS-NSQIP database. Multivariable logistic regression was used to assess independent predictors of 30-day readmission.

RESULTS: Among 5,018 patients undergoing LE bypass, readmission rate was 16.6%. In those readmitted, the most common complications included wound infections (33%), sepsis (5.7%), graft failure (5.1%) and MI (2.6%). Out of 2,204 patients (44%) with complications, 87% had pre-discharge complications and 25% had post-discharge complications. Thirty-day mortality was 129 (2.6%), with 42 (33%) occurring post-discharge. Multivariable predictors of readmission were dependent functional status (OR 1.39, 95% CI 1.1-1.78), cardiac comorbidity (OR 1.43, 95% CI 1.1-1.80), ASA class >4 (OR 1.37, 95% CI 1.1-1.66), obesity (OR 1.31, 95% CI 1.1-1.57), malnutrition (OR 1.40, 95% CI 1.1-1.75), increased operative time (per hour, OR 1.06, 95% CI 1.0-1.12) and return to OR during index admission (OR 7.29, 95% CI 6.1-8.71). On univariate analysis, while many post-discharge complications were associated with readmission (Table 1), the only associated pre-discharge complication was blood transfusion.

CONCLUSIONS: Readmissions are common after lower extremity bypass. Avoidance of infection and optimization of selected chronic conditions may improve readmission rates.

AUTHOR DISCLOSURES: E. Chaikof: Nothing to disclose; T. Curran: Nothing to disclose; M. Fokkema: Nothing to disclose; A. Hamdan: Nothing to disclose; R. C. Lo: Nothing to disclose; M. L. Schermerhorn: Nothing to disclose; M. Wyers: Nothing to disclose; J. Zhang: Nothing to disclose.
 
Complication
30-day complication rate N=5018 (N(%))
Percent of complications occurring after discharge (N(%))
Percent of post-discharge complications that were readmitted (N(%))
Any Complication
2204 (44.9%)
548 (25%)
374 (68%)
Wound infection
552 (11.0%)
409 (74%)
261 (64%)
Superficial SSI
330 (6.6%)
262 (79%)
148 (56%)
Deep SSI
138 (2.8%)
95 (69%)
78 (82%)
Dehiscence
89 (1.8%)
72 (81%)
51 (71%)
Sepsis/septic shock
153 (3.1%)
61 (40%)
60 (98%)
Mechanical ventilation complications
128 (2.6%)
16 (13%)
14 (88%)
MI
114 (2.3%)
22 (19%)
22 (100%)
UTI
89 (1.8%)
28 (31%)
16 (57%)
 
 
Posted April 2013
 

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