88. 90-Day Readmissions in Patients with Diabetic Foot Ulcers Undergoing Soft-tissue Reconstructive Surgery- A Risk Factor Analysis Using the HCUP - Nationwide Readmissions Database

Abstract

PURPOSE: Soft-tissue reconstruction is an integral component in the long-term management of diabetic foot ulcers (DFUs) and is indispensable to mitigating the undue morbidity, mortality, and economic costs associated with DFUs. In this study, we aim to investigate the rate of 90-day readmissions in patients with a DFU who have been treated with a soft-tissue reconstructive surgery. We also intend to characterize the risk factors associated with readmission in this patient cohort. METHODS: We retrospectively queried the Healthcare Cost and Utilization Project’s Nationwide Readmissions database (HCUP-NRD) containing 35 million patient records, from 2016 to 2017, for adult patients who underwent any soft-tissue reconstructive procedure (skin grafting, local flap, and free tissue transfer) for the treatment of a diabetic foot infection. Patient records satisfying the inclusion criteria were extracted using a combination of ICD-10-CM diagnostic codes and ICD-10-PCS procedure codes. Data were weighted and readmissions occuring within the 90 day period of an index admission were estimated in accordance with the HCUP guidelines. A risk factor analysis was performed using univariable and multivariable logistic regression models, with readmission as the dependent variable, to find independent risk factors for readmission in this population. RESULTS: Our final weighted sample cohort consisted of 4,325 adult diabetic patients who had undergone a soft-tissue reconstructive surgery for a diabetic foot infection. Among them, 1,377 patients (31.8%) were readmitted within the 90-day study period. Readmission rate varied depending on the type of procedure performed and was 30.5%, 32.4%, and 38.4% among patients who received skin grafts, local flaps, and free flaps respectively. On performing multivariable analyses, we found that, controlling for all other variables, being operated on in a small metropolitan hospital was associated with 24% lower odds of 90-day readmission as compared to being operated on in a large metropolitan hospital (aOR=0.76, CI=0.60-0.96, p=0.025). However, having chronic kidney disease at baseline was associated with 28% higher odds of 90-day readmission (aOR=1.28, CI=1.02-1.58, p=0.02). Additionally, congestive heart failure at baseline was associated with 55% higher odds of 90-day readmission (aOR=1.55, CI=1.22-1.96, p<0.001). CONCLUSION: Chronic kidney disease and congestive heart failure at baseline were independent risk factors for readmission among patients who underwent soft-tissue reconstruction of the diabetic foot. A multidisciplinary approach to perioperative management of comorbid condit