Hidden Readmissions after Carotid Endarterectomy and Stenting

Area of Science:

• Vascular Surgery
• Health Services Research

Background:

• Carotid procedures historically have a ~6% readmission rate, but prior studies lacked national representation and tracked only index hospital readmissions.
• This study addresses the need for a nationally representative analysis of readmission rates after carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Purpose of the Study:

• To evaluate national readmission rates after CEA and CAS, including those to different hospitals.
• To identify independent risk factors for 30-day readmissions, postoperative mortality, and myocardial infarction (MI) following carotid procedures.

Main Methods:

• Retrospective analysis of the 2010-2014 Nationwide Readmissions Database for patients over 18 undergoing CEA or CAS.
• Univariable and multivariable logistic regression analyses were used to identify risk factors for mortality and 30-day readmissions.
• Outcomes included initial mortality, 30-day readmission rates (index vs. different hospital), mortality, and MI.

Main Results:

• Carotid artery stenting (CAS) was associated with increased mortality risk during index admission (OR 2.29) and 30-day readmission (OR 1.48).
• Approximately 25% of 30-day readmissions (7% overall) occurred at a different hospital, increasing mortality risk (OR 1.45).
• Postoperative infections (15%) and stroke (6%) were significant reasons for readmission.

Conclusions:

• A significant proportion of carotid procedure readmissions occur at different hospitals, indicating care fragmentation that may increase mortality risk.
• Carotid artery stenting (CAS) is an independent risk factor for postoperative mortality and readmissions.
• Further research is needed to reduce unnecessary hospitalizations and improve outcomes after carotid procedures.