Study Analyzes Burden of Readmissions Among CLI Patients

 

March 14, 2017—With readmissions constituting a major health care burden among critical limb ischemia (CLI) patients, Shikhar Agarwal, MD, et al sought to determine the incidence of readmission and factors affecting readmission in CLI patients. The study is available online ahead of print in Journal of the American College of Cardiology (JACC) and will be presented at ACC.17, the American College of Cardiology's 66th annual scientific session being held March 17–19 in Washington, DC.

The study found that readmission rates are high among patients with CLI, and the majority of readmissions are unplanned. Several demographic, clinical, and socioeconomic factors play important roles in predicting readmissions, concluded the investigators.

As summarized in JACC, the study included all adult hospitalizations with a diagnosis code for CLI from State Inpatient Databases from Florida (2009–2013), New York (2010–2013), and California (2009–2011). Data were merged with an American Hospital Association directory to obtain detailed information on hospital-related characteristics. The impact of travel time to the hospital was evaluated using geocoding analysis. 

Of the 695,782 admissions (from 212,241 patients) that were analyzed, there were 284,189 admissions with a principal diagnosis of CLI (primary CLI admissions). 

All-cause readmission rates at 30 days and 6 months were 27.1% and 56.6%, respectively, with the majority of these being unplanned. Unplanned readmission rates at 30 days and 6 months were 23.6% and 47.7% respectively. Major predictors of 6-month unplanned readmissions included age, female gender, black/Hispanic race, previous amputation, Charlson comorbidity index, and need for home health care or rehabilitation facility upon discharge.

Patients covered by private insurance were least likely to be readmitted compared to those with Medicaid/no insurance and Medicare. Travel time to the hospital was inversely associated with 6-month unplanned readmission rates.

There was a significant interaction between travel time and major amputation as well as travel time and revascularization strategy; however, the inverse association between travel time and unplanned readmission rate was evident in all subgroups. Furthermore, length of stay during index hospitalization was directly associated with the likelihood of 6-month unplanned readmission, reported the investigators in JACC.

 

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