Abstract No. 490 Predictors for non-home patient discharge following lower extremity arterial interventions

Abstract

To identify variables associated with patient discharge disposition in order to triage patients who may benefit from additional discharge planning resources and optimize post-procedure care after lower extremity arterial interventions for peripheral artery disease (PAD) The 2014 to 2017 American College of Surgeons National Surgical Quality Improvement Program database was queried using CPT codes for endovascular infrainguinal interventions for PAD. Patients were included if they were inpatients originally admitted from home. The main outcome variable of interest was non-home discharge (e.g., discharge to a skilled nursing or rehabilitation facility). Covariates included patient sociodemographic variables, age quartile (upper quartile ≥ 77 years), comorbidities (diabetes, renal disease, bleeding disorders, CHF, COPD), preprocedural wound, type of procedure, operative time, symptom severity, ASA class, and baseline functional status. Univariate analysis was performed using Fischer’s exact test or chi-squared test where appropriate. Multivariate logistic regression was performed on Stata SE 15.1. A total of 3190 patients met inclusion criteria, of which 664 (20.8%) had non-home discharge. Multivariate regression revealed that age (odds ratio [OR] 1.9 for the upper age quartile [ > 77 years], 95% confidence interval [CI] 1.46–2.50)), operative time (OR 1.2 per increase in quartile, 95% CI 1.09–1.30), preoperative wound (OR 1.5, 95% CI 1.24–1.90), renal failure (OR 1.7, 95% CI 1.30–2.14), congestive heart failure (OR 2.2, 95% CI 1.51–3.24), symptom severity (OR 1.7, 95% CI 1.46–1.98), and independent functional status (OR 0.74, 95% CI 0.59–0.92, P-value 0.007) were associated with non-home discharge. All P values were ≤ 0.001 unless otherwise stated. Patients who are age > 77 or have CHF, renal failure, preoperative wounds, severe symptoms, or prolonged operative time are more likely to require non-home discharge and may benefit from early discharge planning.