Risk Factors Associated 90-Day Readmission among Patients with Peripheral Artery Disease Undergoing Revascularization Procedures

Abstract

Introduction: The CMS Bundled Payments for Care Improvement-Advanced program provides a single payment for all anticipated care within 90-days of surgery. Readmission are an important driver of healthcare cost, however, factors associated with 90-day readmission after peripheral artery disease (PAD) intervention are not well-described. Methods: National cohort of adults over 65 in the Vascular Quality Initiative-CMS linked dataset who underwent open, endovascular, or hybrid procedures for PAD between 2010 and 2018. The primary outcome was 90-day readmission. Multivariable Cox regression analysis was used to evaluate associations between patient- and facility-level characteristics and 90-day readmission. Results: 42,429 patients over age 65 underwent revascularization for PAD during the study period. The median age was 74(69-80), 58.9% were male and 84.3% were White. Over two-thirds of revascularizations were performed via endovascular method and over half had revascularization for chronic limb threatening ischemia (CLTI). The 90-day readmission rate was 30.9%. Patient-level factors such as advanced age, CLTI upon presentation, poor functional status, and most comorbidities of interest were associated with higher 90-day readmission. Those who had an outpatient index revascularization were less likely to have subsequent readmission (ref - inpatient; outpatient [HR 0.60 (95% CI 0.56-0.64)]; office-based lab [HR 0.61 (95% CI 0.51-0.72)]). Conclusion: Patient (e.g., age, comorbidity, severity of PAD upon presentation) and facility (e.g., site of index procedure) characteristics are associated with increased risk for 90-day readmission in PAD patients undergoing revascularization. This data may be used to guide novel intervention that will improve this quality metric among patients undergoing PAD intervention.