Nationwide Database Used to Evaluate 30-Day Readmissions After CLI Revascularization

May 4, 2017—An analysis of the 2013–2014 Nationwide Readmissions Databases evaluating 30-day readmissions after endovascular or surgical therapy for critical limb ischemia (CLI) published by Dhaval Kolte, MD, et al is available online ahead of print in Circulation. The analysis showed that approximately one in five patients hospitalized for CLI and undergoing revascularization is readmitted within 30 days. The risk of readmission in this population was influenced by CLI presentation, patient demographics, comorbidities, and in-hospital complications, but not by the mode of revascularization, concluded the investigators.

The analysis included an index of 60,998 patients hospitalized with CLI with a 30-day readmission rate of 20.4%. The investigators determined the incidence, reasons, and costs of 30-day, unplanned readmission and used hierarchical logistic regression models to identify independent predictors of 30-day readmissions. 

The independent predictors of 30-day readmission identified by the investigators included presentation with ulcer or gangrene, age ≥ 65 years, female sex, large hospital size, teaching hospital status, known coronary artery disease, heart failure, diabetes mellitus, chronic kidney disease, anemia, coagulopathy, obesity, major bleeding, acute myocardial infarction, vascular complications, and sepsis.

Mode of revascularization, however, was not determined to be independently associated with readmissions. The most common reasons for readmission were infections (23.5%), persistent or recurrent manifestations of peripheral arterial disease (22.2%), cardiac conditions (11.4%), procedural complications (11%), and endocrine issues (5.7%). The inflation-adjusted aggregate costs of 30-day readmissions for CLI during the study period were $624 million, reported the investigators in Circulation.