Factors Influencing Hospital Readmission after Lower Extremity Bypass for Chronic Limb-Threatening Ischemia.

Abstract

Objectives: Unplanned hospital readmission is a leading source of hospital resource expenditure, and preventing readmission may improve both patient quality of life and healthcare costs. The factors influencing hospital readmission after lower extremity bypass (LEB) for chronic limb-threatening ischemia (CLTI) remain incompletely investigated. Methods: A regional, multi-institutional database was retrospectively reviewed for all patients who underwent LEB for CLTI between 1995 to 2020. The primary outcome was unplanned hospital readmission up to 30 days following bypass. Results: A total of 1315 patients underwent LEB across all institutions, of whom 843 (64.1%) underwent bypass for CLTI. The 30-day hospital readmission rate was 25.3%, and the leading causes of readmission were wound-related complications (51.6%). There was no difference in age, sex, or race between readmitted and non-readmitted patients. Conduit type and bypass target were also similar between groups. Readmitted patients more frequently underwent LEB for tissue loss (58.2% vs 50.2%, P = 0.042). On multivariable analysis, wound infection (odds ratio [OR] 9.1, 95% confidence interval [CI] 6.2-13.2, P < 0.001) and non-infectious wound complications (OR 2.0, 95% CI 1.0-3.9, P = 0.041) were independently associated with hospital readmission. Factors not associated with hospital readmission included patient age, conduit type, distal bypass target, and other medical comorbidities. Conclusions: One quarter of patients are readmitted within 30days following lower extremity bypass for chronic limb-threatening ischemia. Efforts to mitigate wound infection and non-infectious wound complications may decrease rates of unplanned hospital readmission.