Abstract 193: Primary Care Utilization Reduces Risk of Readmission among High-Risk Vascular Surgery Patients: Coordinating of Post-Discharge Care Matters

Abstract

Objectives: Readmissions are a common and costly occurrence following high-risk surgical procedures, but may be avoided if problems are identified early in the post-discharge period. We hypothesized that routine follow-up with a primary care provider (PCP) might reduce 30-day readmissions following a high-risk vascular surgery procedure, thoracic aortic aneurysm (TAA) repair. Methods: We conducted a retrospective cohort study of 42,935 Medicare beneficiaries who were discharged home from US hospitals following open TAA repair in 2003-2010. Primary care utilization was determined within 307 hospital referral regions described by the Dartmouth Atlas, as well as using a 20% sample of Medicare claims for outpatient primary care services within 30-days following TAA repair. We used hierarchical regression models, adjusted for patient and regional level differences, to examine the relationship between primary care utilization with 30-day readmission & mortality following TAA repair. Results: 8,429 (20%) patients were readmitted within 30-days after open TAA repair, and more than 42% of readmissions occurred by 11 days post discharge. Among patients discharged following an uncomplicated hospital course, follow-up with a PCP within 30-days significantly reduced the risk of readmissions (Figure). Even after adjusting for differences in age, race, gender, and complications, PCP follow-up reduced the likelihood of 30-day readmission following TAA repair by over 30% (OR: 0.69; 95%CI: 0.49-0.97; P<0.05). As with most major surgical procedures, readmissions following TAA repair were more likely to occur among patients experiencing postoperative complications (21% vs. 19%, P<0.01). Finally, readmissions were less likely to occur in hospital referral regions with high primary care utilization as compared to regions with low rates of primary care utilization (19.4% high vs. 23.6% low; P<0.01). Conclusions: Medicare recipients discharged following open TAA repair were significantly less likely to be readmitted in regions with high primary care utilization and when primary care follow-up occurred after surgery. These results highlight the need for better coordination of care between surgeons and primary care providers, and suggest an opportunity to focus quality improvement efforts to limit readmission.