Nationwide Cohort Study Evaluates Readmissions After Revascularization Procedures for PAD
December 6, 2017—In Annals of Internal Medicine, Eric A. Secemsky, MD, et al published findings online from a retrospective cohort study that sought to evaluate nationwide readmissions after revascularization for peripheral artery disease (PAD) and to assess whether readmission risk varies among hospitals. The background of the investigation is that limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for PAD; however, the overall burden of readmissions has not been comprehensively explored.
As summarized in Annals of Internal Medicine, the study involved 1,085 acute care hospitals in the United States participating in the Nationwide Readmissions Database. There were 61,969 unweighted hospitalizations of patients with PAD who had peripheral artery revascularization and were discharged between January 1 and November 30, 2014.
The investigators measured 30-day readmission rates, causes, and costs of unplanned rehospitalizations after peripheral artery revascularization. Additionally, 30-day risk-standardized readmission rates were calculated using hierarchical logistic regression to assess heterogeneity of readmission risk between hospitals.
For the 61,969 hospitalizations of patients with PAD who were discharged after peripheral artery revascularization, the 30-day nonelective readmission rate was 17.6%. The most common cause of readmission was procedural complications (28%), followed by sepsis (8.3%) and complications due to diabetes mellitus (7.5%). Among rehospitalized patients, 21% underwent a subsequent peripheral artery revascularization or lower extremity amputation, 4.6% died, and the median cost of readmission was $11,013. Thirty-day risk-standardized readmission rates varied from 10% to 27.3% (interquartile range, 16.6%–18.8%).
The investigators concluded that more than one in six patients with PAD who undergo peripheral artery revascularization have an unplanned readmission within 30 days, with high associated mortality risks and costs. Procedure- and patient-related factors were the primary reasons for readmission. Readmission rates moderately varied between institutions after hospital case mix was accounted for, suggesting that differences in hospital quality may only partially account for readmission.
A limitation of the study was the inability to distinguish out-of-hospital deaths after discharge and potential misclassification bias due to use of billing codes to ascertain diagnoses and interventions, noted the investigators in Annals of Internal Medicine.