Predictors of 30-Day Readmission and Analysis of Complications After Lower Extremity Bypass Using NSQIP

Abstract

Objectives: Readmission is associated with high mortality, morbidity, and cost. We used the NSQIP to determine predictors of 30-day readmission rates Methods: We identified all patients who received lower extremity (LE) bypass in the 2011 ACS-NSQIP database. Multivariable logistic regression was used to assess independent predictors of 30-day readmission. Results: Among 5018 patients undergoing LE bypass, readmission rate was 16.6%. In those readmitted, the most common complications included wound infections (33%), sepsis (5.7%), graft failure (5.1%), and MI (2.6%). Out of 2204 patients (44%) with complications, 87% had pre-discharge complications and 25% had postdischarge complications. Thirty-day mortality was 129 (2.6%), with 42 (33%) occurring postdischarge. Multivariable predictors of readmission were dependent functional status (OR, 1.39; 95% CI, 1.1-1.78), cardiac comorbidity (OR, 1.43; 95% CI, 1.1-1.80), ASA class >4 (OR, 1.37; 95% CI, 1.11.66), obesity (OR, 1.31; 95% CI, 1.1-1.57), malnutrition (OR, 1.40; 95% CI, 1.1-1.75), increased operative time (per hour, OR, 1.06; 95% CI, 1.0-1.12), and return to OR during index admission (OR, 7.29; 95% CI, 6.1-8.71). On univariate analysis, while many postdischarge complications were associated with readmission (Table), the only associated predischarge complication was blood transfusion. Conclusions: Readmissions are common after lower extremity bypass. Avoidance of infection and optimization of selected chronic conditions may improve readmission rates.