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 SS14. Predictors and Consequences of Unplanned Hospital Readmission Within 30 days of Carotid Endarterectomy

Karen J. Ho1, Arin L. Madenci2, James T. McPhee3, Marcus E. Semel1, Louis L. Nguyen1, C. K. Ozaki1, Michael Belkin1
1Surgery, Brigham and Women's Hospital, Boston, MA; 2University of Michigan Medical School, Ann Arbor, MI; 3Boston Medical Center, Boston, MA.

OBJECTIVES: Carotid endarterectomy (CEA) is the operation vascular surgeons perform most frequently in the United States. Given the resource burden of unplanned readmissions (URA), we sought to identify the predictors/consequences of URA within 30 days of CEA for potential points of intervention.
 
METHODS: Retrospective analysis of consecutive CEAs (2001-2011) at a single institution. Primary endpoint was URA within 30 days. Factors crudely associated with URA at p<0.05 were included in the stepwise multivariable analysis. Death through 1 year was compared with the log rank test for the Kaplan-Meier estimator.
 
RESULTS: Eight hundred forty patients underwent 896 CEAs. Median postop LOS was 1 day (interquartile range [IQR] 1-2). Overall, 30-day readmission rate was 8.6% and URA rate was 6.5%. The most frequent reasons for URA were cardiac, other medical complications and headache. Nearly half of the URA patients (27, 46.5%) were readmitted for a CEA-related reason (headache, cardiac, hypertension, wound infection, bleeding/hematoma, stroke/TIA, dysphagia, hyperperfusion syndrome). Sixteen (27.5%) patients had more than one reason for URA. Median time to URA was 4 days (IQR 1-9). Unadjusted risk factors for URA were history of CAD, CABG or CHF and postop in-hospital occurrence of stroke, bleeding/hematoma, myocardial infarction or CHF. Hospital LOS, indication for CEA and discharge destination were not associated with URA. In multivariable analysis, prior CABG (adjusted odds ratio [OR] 2.2, 95% CI 1.2-3.9; p=0.009) and postop in-hospital stroke (OR7.1, 95%CI 2.0-25.1; p=0.003), bleeding/hematoma (OR3.3, 95% CI 1.4-8.2; p=0.009) and CHF (OR55.2, 95% CI 5.5-52.5; p=0.006) were significantly associated with URA. URA was associated with increased mortality over 1 year (log rank test, p=0.02).
 
CONCLUSIONS: The 30-day URA rate after CEA is low (6.5%). Prior CABG and in-hospital postop occurrence of stroke, bleeding/hematoma and CHF identify those at increased risk of URA. URA may signal increased long-term risk of post-operative mortality.
 
AUTHOR DISCLOSURES: M. Belkin: Nothing to disclose; K. J. Ho: Nothing to disclose; A. L. Madenci: Nothing to disclose; J. T. McPhee: Nothing to disclose; L. L. Nguyen: Nothing to disclose; C. K. Ozaki: Nothing to disclose; M. E. Semel: Nothing to disclose.
 
Posted April 2013

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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.