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 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%
Posted April 2013

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