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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.

Keywords

Endovascular repair of abdominal aortic aneurysm abdominal aortic aneurysm readmission

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References

Jencks

Williams

and Coleman

EA.

Rehospitalizations among patients in the Medicare fee-for-service program.

N Engl J Med 2009; 360: 1418–1428.

Affordable Care Act. Available at: https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf (accessed 16 November 2016).

CMS proposals to improve quality of care during hospital inpatient stays. Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-04-30-2.html (accessed 16 November 2016).

Jackson

Nathan

Doctor

et al . Low rehospitalization rate for vascular surgery patients. J Vasc Surg 2011; 54: 767–772.

Dua

Kuy

Lee

et al . Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010. J Vasc Surg 2014; 59: 1512–1517.

American college of Surgeons, National Surgical Quality Improvement Program. Available at: https://www.facs.org/quality-programs/acs-nsqip ANPAa (accessed 3 June 2017).

Daley

Khuri

Henderson

et al . Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 328–340.

Bilimoria

Cohen

Ingraham

et al . Effect of postdischarge morbidity and mortality on comparisons of hospital surgical quality. Ann Surg 2010; 252: 183–190.

Shiloach

Frencher

Jr Steeger

et al . Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210: 6–16.

10.

Khuri

Daley

Henderson

et al . Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 315–327.

11.

Khuri

Daley

Henderson

et al.

The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 1995; 180: 519–531.

12.

Parodi

Palmaz

and Barone

HD.

Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.

Ann Vasc Surg 1991; 5: 491–499.

13.

Prinssen

Wixon

Buskens

et al . Surveillance after endovascular aneurysm repair: diagnostics, complications, and associated costs. Ann Vasc Surg 2004; 18: 421–427.

14.

Participants

Et.

Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial.

Lancet 2005; 365: 2179–2186.

15.

Kansagara

Englander

Salanitro

et al . Risk prediction models for hospital readmission: a systematic review. JAMA 2011; 306: 1688–1698.

16.

Rosen

Chen

Shin

et al . Medical and surgical readmissions in the Veterans Health Administration: what proportion are related to the index hospitalization? Med Care 2014; 52: 243–249.

17.

Aziz

Lehman

and Reed

AB.

Unplanned return to operating room after lower extremity arterial bypass is an independent predictor for hospital readmission.

J Vasc Surg 2016; 63: 678–687 e2.

18.

Ali

Lehman

EB and

Aziz

Unplanned return to operating room after lower extremity endovascular intervention is an independent predictor for hospital readmission. J Vasc Surg 2017; 65: 1735–1744.e2.

19.

Ferris

and Torchiana

DF.

Public release of clinical outcomes data-online CABG report cards.

N Engl J Med 2010; 363: 1593–1595.

20.

Gawande

Thomas

Zinner

et al . The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 1999; 126: 66–75.

21.

Feldman

Barkun

et al . Measuring postoperative complications in general surgery patients using an outcomes-based strategy: comparison with complications presented at morbidity and mortality rounds. Surgery 1997; 122: 711–719; discussion 9–20.

22.

Brooke

De Martino

Girotti

et al . Developing strategies for predicting and preventing readmissions in vascular surgery. J Vasc Surg 2012; 56: 556–562.

23.

Giles

Landon

Cotterill

et al . Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg 2011; 53: 6–12,3 e1.

24.

Durham

Mohr

Parker

et al . The impact of socioeconomic factors on outcome and hospital costs associated with femoropopliteal revascularization. J Vasc Surg 2010; 52: 600–606; discussion 6–7.

25.

Naylor

Aiken

Kurtzman

et al . The care span: the importance of transitional care in achieving health reform. Health Aff 2011; 30: 746–754.

26.

Promoting greater efficiency in Medicare. Medicare payment advisory comission. Available at: http://medpac.gov/documents/reports/Jun07_EntireReport.pdf?sfvrsn=0 (accessed 16 November 2016).

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

Abstract

Objectives

Methods

Results

Conclusions

Keywords

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References