Return to Operating Room After Lower Extremity Arterial Bypass Is an Independent Predictor for Hospital Readmission

Abstract

Hospital readmissions after surgical operations are considered as serious complications and affect health care associated costs. The Centers for Medicare and Medicaid services (CMS) strongly encourages identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery. The 2013 lower extremity revascularization-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission ≤30 days after surgery. A total of 2646 patients (males, 35%; females, 65%) underwent lower extremity revascularization during 2013. Indications for operations included tissue loss (39%), rest pain (32%), and severe claudication (25%). Preoperative ankle-brachial indices were 0.4 to 0.9 in 32% and <.4 in 16.5%. A total of 425 patients (16%) were readmitted ≤30 days of the index operation. Risk factors associated with readmission included return to operation room (odds ratio [OR], 9.2), wound infection (OR, 8.5), limb amputation (OR, 5.4), postoperative deep vein thrombosis (OR, 3.8), and major reintervention on bypass (OR, 3.4; P < .05; Fig). Readmission after lower extremity bypass surgery is a serious complication. Various factors put a patient at a high risk for readmission. Return to the operating room, wound infection, amputation, deep vein thrombosis, and major reintervention on bypass are independent risk factors for hospital readmission. Return to the operating room is associated with a ninefold increase in hospital readmission.