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