Thirty-day readmission after lower extremity bypass in diabetic patients

Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics and is associated with readmission. Thus, we hypothesized that diabetes might be a predictor of 30-d unplanned readmission after LEB.

Patients undergoing infrainguinal LEB in the 2011-12 American College of Surgeons National Surgery Quality Improvement Program database were divided into nondiabetics mellitus (NDM), non-insulin-dependent diabetics mellitus (NIDDM), and insulin-dependent diabetic mellitus (IDDM). Univariate and multivariate analyses were used to evaluate the influence of diabetes on 30-d readmission.

A total of 9207 patients (5155 [56%] NDM, 1690 (18%) NIDDM, and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 patients (16%). IDDM had significantly higher crude postoperative complication (43% versus 30% NDM, 36% NIDDM; P < 0.001) and unplanned readmission rates (20% versus 14% NDM, 16% NIDDM; P < 0.001). Concomitant cardiac disease significantly modified the association between diabetes and unplanned readmission. On multivariable analysis, IDDM was an independent predictor of unplanned readmission in the absence of cardiac disease (odds ratio [OR] = 1.23; 95% confidence interval [CI], 1.03-1.47; P = 0.01). However, this association did not remain significant in the presence of cardiac disease (OR = 0.70; 95% CI, 0.48-1.01; P = 0.56). On subgroup analysis of those without cardiac disease, cardiac complications were a significant risk factor for readmission in IDDM (OR = 2.00; 95% CI, 1.12-3.57; P = 0.02) but not NDM (P = 0.31) or NIDDM (P = 0.10).

Although post-LEB unplanned readmission was more common among diabetics, IDDM was independently associated with unplanned readmission only in those without cardiac disease. This was driven, in part, by increased cardiac complications. Therefore, a more stringent preoperative cardiac workup in this group should be considered before LEB.