Travis L. Engelbert, Sara Fernandes-Taylor, Dan Miller, Richard S. Saunders, Katrina Lorfeld, Lauren Dallman, Mary Randel, Caprice Greenberg, K. Craig Kent, Jon Matsumura
Vascular Surgery, UW Hospitals and Clinics, Madison, WI.
OBJECTIVES: Early hospital readmissions after vascular surgery are frequent, costly and often preventable. Interventions to reduce readmissions have mainly targeted medical cohorts owing to recent Medicare financial penalties. These penalties will soon be instituted for vascular surgery. We examine the characteristics of readmission after vascular surgery at a tertiary-care institution to develop strategies for improving care.
METHODS: For 1 year (July 2011 to June 2012), we queried the hospital medical record to determine readmission rates and characteristics of patients who were discharged from the vascular surgery service and were readmitted to the same institution within 30 days.
RESULTS: Of 633 vascular service patients, 10.4% (66) were readmitted within 30 days. Readmitted vascular patients were predominantly covered by Medicare (78.8%). Common principal diagnoses of the readmission were surgical complications (43.9%), almost half of which were an infected surgical wound or device. Medical complications, including pneumonia and GI hemorrhage, were also common (28.8%). Additional readmitting diagnoses were heterogeneous (27.3%) (e.g., fractures, medication issues and planned readmissions). Almost half (43.9%) of readmitted patients returned to a hospital service other than vascular surgery. Moreover, 24.7% of patients discharged to skilled nursing facilities (SNFs) were readmitted, comprising 30.3% of total vascular readmissions; 68.4% of these patients returned to SNFs after readmission.
CONCLUSIONS: Vascular surgery patients present with a broad range of diagnoses at readmission; surgical complications and infections are the most common reasons for readmission. Patients discharged to SNF and patients suffering postoperative infections are essential targets for reducing readmission. Institutional efforts to reduce and manage readmission after vascular surgery will focus on infection management, appropriate SNF discharge and coordination, and discharge planning to ensure same-service readmission.
AUTHOR DISCLOSURES: L. Dallman: Nothing to disclose; T. L. Engelbert: Nothing to disclose; S. Fernandes-Taylor: Nothing to disclose; C. Greenberg: Nothing to disclose; K. Kent: Nothing to disclose; K. Lorfeld: Nothing to disclose; J. Matsumura: Nothing to disclose; D. Miller: Nothing to disclose; M. Randel: Nothing to disclose; R. S. Saunders: Nothing to disclose.
Posted April 2013