Risk score for nonhome discharge after lower extremity bypass

Area of Science:

• Vascular Surgery
• Health Services Research
• Predictive Analytics

Background:

• Lower extremity bypass (LEB) for peripheral artery disease (PAD) necessitates significant healthcare resources, including post-discharge care.
• Factors influencing nonhome discharge (NHD) after LEB are not well-established.
• Predicting NHD is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To develop and validate a novel risk score to predict NHD in patients undergoing LEB for PAD.
• To identify key preoperative risk factors associated with NHD.

Main Methods:

• Analysis of the Vascular Study Group of New England database (2003-2017) for elective LEB procedures.
• Exclusion of non-elective cases, patients not admitted from home, bedridden patients, and in-hospital deaths.
• Development of a logistic regression model using preoperative factors to predict NHD, split into derivation and validation cohorts.

Main Results:

• The study included 10,145 patients, with an overall NHD rate of 26.4%.
• Multivariable analysis identified age, sex, nonwhite race, tissue loss, cardiac comorbidity, partial ambulatory deficit, and insulin-dependent diabetes as significant predictors of NHD.
• The developed risk score demonstrated strong predictive performance (C-statistic 0.78-0.79) and categorized patients into low, moderate, and high-risk groups for NHD.

Conclusions:

• A novel, preoperative risk score effectively predicts NHD after LEB for PAD.
• High-risk patients (12% of LEB cohort) constitute a disproportionate number (nearly one-third) of NHD cases.
• This risk score can enhance preoperative counseling, improve patient management, and optimize hospital resource allocation.