Unplanned readmission to the hospital appears common after revascularization for peripheral arterial disease (PAD), according to a new study.
Researchers performed a retrospective cohort study involving 1,085 acute care hospitals in the U.S. that were participating in the Nationwide Readmissions Database. The goal of the study was to determine the rate of readmissions and whether readmission risk after peripheral arterial revascularization varies by hospital. The main outcome measures were 30-day readmission rates, causes, and costs of unplanned rehospitalizations after peripheral arterial revascularization. In addition, 30-day risk-standardized readmission rates were calculated to determine heterogeneity of readmission risk between hospitals. The study results were published online Dec. 5 by Annals of Internal Medicine.
Overall, 61,969 hospitalizations of patients with PAD who were discharged alive after undergoing revascularization were included in the study, using data from Jan. 1 to Nov. 30, 2014. The mean patient age was 68 years, and 38% of patients were women. At 30 days, the rate of nonelective readmissions was 17.6%. Patients were most commonly readmitted for procedural complications, sepsis, diabetes-related complications, and gangrene (28.0%, 8.3%, 7.5%, and 5.1%, respectively). Of patients who were readmitted, 21.0% had another peripheral revascularization or lower-extremity amputation during their rehospitalization and 4.6% died. Readmission had a nationally weighted median cost of $11,013. Risk-standardized readmission rates at 30 days, which accounted for hospital case-mix, ranged from 10.0% to 27.3%.
The authors noted that their data depended on billing codes; that detailed data at the patient, operator, and procedure level were not available; and that they did not have information on out-of-hospital death. However, they concluded that their study indicated an association between revascularization for PAD and high rates of 30-day unplanned hospital readmissions that are expensive and are linked to a high mortality risk. They also pointed out that differences in hospital quality appeared to be only partially responsible for readmission rates. “Procedure- and patient-related factors were the most common reasons for rehospitalization,” the authors wrote. “As such, future strategies to reduce the need for readmission should prioritize improving postdischarge patient care for these high-risk patients.”