Vascular Web Logo

SVS  SVS Foundation
A A A
VascularWeb

 RR17. Predictors of 30-Day Readmission and Post-Discharge Mortality Following Carotid Endarterectomy in the ACS-NSQIP

Thomas Curran, Ruby C. Lo, Margriet Fokkema, 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 mortality following carotid endarterectomy (CEA) in the ACS-NSQIP.
 
METHODS: All patients undergoing CEA without concurrent cardiac procedure in the 2011 NSQIP were identified. Independent predictors of 30-day readmission and post-discharge mortality were determined using multivariable logistic regression.
 
RESULTS: We identified 8,836 patients (38% symptomatic) undergoing CEA with readmission occurring in 667 (7.5%; symptomatic: 10%; asymptomatic: 7%; p<.01). Post-operative stroke rate was 1.2% (n=107) with 36% taking place post-discharge. Thirty-day mortality rate was 0.9% (n=80) with 45% happening post-discharge. Overall complication rate was 9.4%. Twenty-seven percent of complications occurred post-discharge with 70% of these undergoing readmission. Strongest independent predictors of readmission included OR take-back (OR: 9.2; 95% CI: 7.1-12.0), preoperative nursing home residence (OR: 2.7; 95% CI: 1.6-4.5), symptom status (OR: 1.4; 95% CI: 1.1-1.8), underweight (OR: 1.8; 95% CI: 1.1-2.9), CKD (OR: 1.3; 95% CI: 1.1-1.5) and anemia (OR: 1.5; 95% CI: 1.1-2.2).
 
CONCLUSIONS: Half of post-operative deaths and a quarter of complications occur post-discharge with post-discharge complications often leading to readmission. Patient selection and close follow up may play a role in mitigating adverse events following CEA.
 
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
Return to OR​ ​3.1% ​n/a ​n/a
MI​ ​1.2% ​22% ​88%
​Stroke ​1.2% ​36% ​89%
​Pneumonia ​1% ​34% ​86%
​UTI ​1% ​63% ​44%
Sepsis​ 0.6% ​54%
​96%
 
 
Posted April 2013

Contact Us

Society for Vascular Surgery
633 North Saint Clair Street, 22nd Floor | Chicago, IL 60611
Phone: 312-334-2300 | 800-258-7188
Fax: 312-334-2320
Email: vascular@vascularsociety.org

Follow Us

YouTube

VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.