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Readmission rates after lower extremity bypass vary significantly by surgical indication
Caroline E Jones1, Joshua S Richman1, Daniel I Chu1
1Department of Surgery, University of Alabama-Birmingham, Birmingham, Ala.
Insights
Thirty-day readmission rates for lower extremity bypass surgery are significantly higher for patients with critical limb ischemia tissue loss or rest pain compared to claudication. Adjusting for surgical indication is crucial when reporting readmission rates.
Area of Science:
- Vascular Surgery Outcomes
- Health Services Research
- Surgical Quality Improvement
Background:
- Vascular surgery, particularly lower extremity bypass, faces high readmission rates.
- Understanding readmission drivers is essential for improving patient outcomes and hospital performance metrics.
Purpose of the Study:
- To analyze 30-day readmission rates after lower extremity bypass.
- To determine how readmission rates and risk factors differ based on the surgical indication.
Main Methods:
- Utilized the 2012-2014 American College of Surgeons National Surgical Quality Improvement Program vascular cohort.
- Excluded emergent procedures and planned readmissions; stratified patients by indication: claudication, critical limb ischemia rest pain (CLI RP), critical limb ischemia tissue loss (CLI TL), and other.
- Employed logistic regression to identify predictors of readmission, adjusting for preoperative factors.
Main Results:
- Overall 30-day readmission rate was 14.8% among 6112 patients.
- Readmission rates varied significantly by indication: CLI TL (18.8%), CLI RP (16.5%), claudication (9.4%), and other (8.2%).
- Adjusted analysis showed higher readmission odds for CLI TL (OR 1.67) and CLI RP (OR 1.70) compared to claudication.
Conclusions:
- Surgical indication is a significant factor influencing 30-day readmission rates after lower extremity bypass.
- Public reporting and penalties for readmissions should account for these variations by indication.
- Risk adjustment models must incorporate surgical indication to accurately assess hospital performance.
Objective:
Readmission rates after vascular surgery are among the highest within surgical specialties, and lower extremity bypass has the highest readmission rate of vascular surgery procedures. We analyzed how 30-day readmissions and risk factors for readmissions vary by indication for lower extremity bypass.
Methods:
We queried the 2012-2014 American College of Surgeons National Surgical Quality Improvement Program procedure-targeted vascular cohort to identify all patients who underwent lower extremity bypass. Emergent procedures and planned readmissions were excluded. Patients were stratified by surgical indication: claudication, critical limb ischemia rest pain (CLI RP), critical limb ischemia tissue loss (CLI TL), and other. The χ2 and Wilcoxon rank sum tests were used to test the differences between categorical and continuous variables, respectively. Logistic regression was used to estimate odds ratios for predictors of readmission adjusted for preoperative factors that were selected a priori.
Results:
The overall 30-day readmission rate among the 6112 patients who underwent lower extremity bypass was 14.8%. Readmission rates varied significantly on the basis of the indication for surgery. In unadjusted comparisons, 18.8% of patients with CLI TL were readmitted compared with 16.5% with CLI RP, 9.4% with claudication, and 8.2% with other indications (P < .001). After adjustment for preoperative factors, 30-day readmissions were higher for patients with CLI TL (odds ratio, 1.67; 95% confidence interval, 1.35-2.06) and CLI RP (odds ratio, 1.70; 95% confidence interval, 1.38-2.09) compared with patients with claudication.
Conclusions:
The 30-day readmission rates after lower extremity bypass vary significantly by surgical indication. Because lower extremity bypasses are performed for multiple indications, if readmission rates are publically reported and hospitals can be penalized for higher than expected readmission rates, the expected readmission rates should be adjusted for surgical indication.
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