Unplanned return to operating room after endovascular repair of abdominal aortic aneurysm (EVAR) is associated with increased risk of hospital readmission.

Abstract

Objectives Hospital readmissions after surgical operations are considered serious events. Centers for Medicare and Medicaid (CMS) consider surgical readmissions as preventable and hold hospitals responsible for them. Endovascular abdominal aortic aneurysm (EVAR) has become the first line modality of treatment for suitable patients with abdominal aortic aneurysm (AAA). The purpose of this study is to retrospectively review the factors associated with hospital readmission after EVAR. Methods The 2013 EVAR targeted American College of Surgeons (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP participant use files were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing EVAR surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery. Results A total of 2277 patients (81% males, 19% females) underwent EVAR operations in the year 2013. Indications for operations included: asymptomatic large diameter (79%), symptomatic (5.7%), rupture without hypotension (4.3%), and rupture with hypotension (2.8%). Among these patients, 178 (7.8%) were readmitted to the hospital within 30 days after surgery. About 53% of all readmissions were within two weeks after the discharge. Risk factors, associated with readmission included: body mass index (per 5-units, OR 1.23, CI 1.06-1.42, p < 0.05), days from admission to operation (per 1 day, OR 1.26, CI 1.12-1.41, p < 0.05), prior abdominal aortic surgery (OR 1.60, CI 1.10-2.31, p < 0.05), urinary tract infection (OR 5.93, CI 2.09-16.88, p < 0.05), superficial surgical site infection (OR 6.57, CI 2.53-17.09, p < 0.05), unplanned return to the operating room (OR 11.29, CI 6.29-20.28, p < 0.05), myocardial infarction (OR 11.30, CI 4.42-28.89, p < 0.05), deep venous thrombosis (OR 11.52, CI 2.89-45.86, p < 0.05 and deep incisional surgical site infection (OR 38.0, CI 2.87-373.56, p < 0.05). Risk of readmission for patients with presence of all these seven factors was 99.9%. Conclusions Readmission after EVAR is a serious occurrence. Various factors predispose a patient at a high risk for readmission. Unplanned return to operating room after EVAR is associated with a 11-fold increase in hospital readmission.