Impact of Patient Factors and Procedure on Readmission After Aortic Dissection Admission

Abstract

Introduction: Aortic dissection (AD) admissions carry significant morbidity and mortality. However, readmissions after AD admission are not well described. Using state based administrative claims data from the U.S.A., we sought to define readmission rates after AD and identify factors associated with them. Methods: State Inpatient Databases for the states of Florida (FL, 2005-2014) and New York (NY, 2006-2014) were queried for index admissions for AD (no prior admission for AD). Admissions were stratified by initial treatment strategy (TASR – Type A open surgery repair, TBSR – Type B open surgery repair, TEVAR – thoracic endovascular repair, MM – medical management). Readmissions rates were calculated at 30-days, 90-days and 2 years. Logistic regression was used to identify factors associated with readmission at each time point. Results: We identified 4,670 patients with an index AD admission. Treatment was with TASR (22%, 1,031), TBSR (16%, 761), TEVAR (9%, 412) and MM (53%, 2466). Patients were predominantly male (59.4%) and white (61.9%) with a median age of 66 years. MM patient were older (median 71 years) and more often women (46.7%, p<0.001 across all groups). Readmission was observed at 30-days, 90-days, and 2-years in 9%, 15%, and 44% of patients. Older age was associated with lower readmissions at 2 years (OR 0.99, 95%CI 0.98-0.99, p<.001) and TEVAR was associated with higher readmission at 2 years (OR 1.3, 95%CI 1.05-1.62, p=.02) when compared to MM. The second, third, and fourth quartiles of median household income by postal code all had lower odds of 30-day readmission compared to the first quartile (OR 0.66, 95%CI 0.5-0.9; 0.73, 95% CI 0.53-0.99; 0.73, 95% CI 0.31-0.58, respectively; p<0.05 for all). Hispanic (OR 1.36, 95%CI 1.1-1.69, p=.005) and black patients (OR 1.59, 95%CI 1.35-1.88, p<.001) had higher readmission rates at 2 years when compared to white patients. Private payer insurance was associated with higher 30-day readmission when compared to Medicare (federal health insurance program for elderly; OR 1.46, 95%CI 1.07-1.98 p=.016), but lower 2-year readmission (OR 0.69, 95%CI 0.56-0.84, p<.001). Readmission rates were higher in NY at 30-days, 90-days, 2-years (OR 1.3, 95%CI 1.05-1.64; 1.2, 95%CI 1.02-1.45; 1.3, 95%CI 1.13-1.47 respectively, p<0.05 for all) compared to FL. At all three time points, AD was the most common diagnosis for readmission. Conclusion: In state 30- and 90-day readmission rates after AD are lower than other vascular related admissions and were not associated with treatment type. Two-year readmissions are common. Early readmission appears to be correlated with lower socioeconomic status while late readmissions are associated with Medicare insurance and TEVAR. These data may suggest a disparity in care for specific patient populations with AD for targeted improvement.