Risk factors associated with 30-day hospital readmission after carotid endarterectomy
Drew J Braet1, Jamie B Smith2, Jonathan Bath1
1Division of Vascular Surgery, School of Medicine, 14716University of Missouri, Columbia, MO, USA.
Insights
Readmissions after carotid endarterectomy are linked to factors like end-stage renal disease, bleeding complications, and electrolyte imbalances. Optimizing physician-modifiable factors, such as protamine use to prevent bleeding, can reduce readmissions.
Area of Science:
- Vascular Surgery
- Health Services Research
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Understanding readmission drivers is crucial for improving patient outcomes and healthcare costs.
Purpose of the Study:
- To evaluate all-cause 30-day readmissions following carotid endarterectomy.
- To identify patient and procedural factors associated with these readmissions.
Main Methods:
- Retrospective analysis of 5257 patients undergoing carotid endarterectomy from the Cerner Health Facts® database.
- Chi-square analysis and multivariate logistic regression identified factors associated with 30-day readmission.
Main Results:
- The 30-day readmission rate was 3.1%.
- Independent predictors of readmission included end-stage renal disease, hemorrhage/hematoma, procedural complications, bronchodilator use, higher Charlson index scores, and electrolyte abnormalities (hyponatremia, hypokalemia).
Conclusions:
- Key factors influencing readmission include comorbidities (especially end-stage renal disease), bleeding complications, electrolyte imbalances, and bronchodilator use.
- Underutilization of protamine, a medication that can reduce bleeding, was noted.
- Addressing physician-modifiable factors like bleeding prevention is essential for reducing readmissions and improving reimbursement in value-based care models.
Objective:
The current study evaluated all-cause 30-day readmissions after carotid endarterectomy.
Methods:
Patients undergoing carotid endarterectomy were selected from the Cerner Health Facts® database using ICD-9-CM procedure codes from their index admission. Readmission within 30 days of discharge was determined. Chi-square analysis determined characteristics of the index admission (demographics, diagnoses, postoperative medications, and laboratory results) associated with readmission. Multivariate logistic regression models were used to identify characteristics independently associated with readmission.
Results:
In total, 5257 patients undergoing elective carotid endarterectomy were identified. Readmission within 30 days was 3.1%. After multivariable adjustment, readmission was associated with end-stage renal disease (OR: 3.21, 95% CI: 1.01-10.2), hemorrhage or hematoma (OR: 2.34, 95% CI: 1.15-4.77), procedural complications (OR: 3.07, 95% CI: 1.24-7.57), use of bronchodilators (OR: 1.48, 95% CI: 1.03-2.11), increased Charlson index scores (OR: 1.22, 95% CI: 1.08-1.38), and electrolyte abnormalities (hyponatremia < 135 mEq/L (OR: 1.69, 95% CI: 1.07-2.67) and hypokalemia less than 3.7 mEq/L (OR: 2.26, 95% CI: 1.03-4.98)).
Conclusions:
Factors associated with readmission following carotid endarterectomy included younger age, increased comorbidity burden, end-stage renal disease, electrolyte disorders, the use of bronchodilators, and complications including bleeding (hemorrhage or hematoma). Of note, in this real-world study, only 40% of the patients received protamine, despite evidence-based literature demonstrating the reduced risk of bleeding complications. As healthcare moves towards quality of care-driven reimbursement, physician modifiable targets such as protamine utilization to reduce bleeding are greatly needed to reduce readmission, and failure to reduce preventable physician-driven complications after carotid interventions may be associated with decreased reimbursement.
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