A national analysis of rehospitalizations following open lower extremity revascularization

Open lower extremity revascularization remains an important therapy for patients with severe peripheral artery disease. Despite open lower extremity revascularization often providing long-term patency, readmissions remain a significant concern. Using a nationally representative cohort, we evaluated patient and clinical factors associated with 30-day nonelective readmission following open lower extremity revascularization.

All adult (≥18 years) hospitalizations for patients undergoing isolated open lower extremity revascularization were identified using the 2012-2022 American College of Surgeons National Surgical Quality Improvement Program. Patients were grouped into the readmitted and not-readmitted cohorts, respectively. Multivariable regression models were developed to assess the association between patient and operative characteristics with readmission status.

Of an estimated 25,768 patients undergoing open lower extremity revascularization, 15.6% were nonelectively readmitted within 30 days. Over the study period, open lower extremity revascularization volume declined significantly, whereas readmission rates remained stable (both nptrend <0.001). Readmitted patients more frequently presented with chronic limb-threatening ischemia (81.4% vs 70.7%) and had higher rates of major complications (80.3% vs 30.2%, both P < .001). After risk adjustment, factors independently associated with increased odds of readmission included female sex (adjusted odds ratio, 1.15; 95% confidence interval, 1.07-1.24), Black race (adjusted odds ratio, 1.14; 95% confidence interval, 1.04-1.25), and chronic limb-threatening ischemia (adjusted odds ratio, 1.84; 95% confidence interval, 1.40-2.40).

Despite declining utilization of open lower extremity revascularization nationally, readmissions remain a concern, with several patient and clinical factors being associated with an increased likelihood of readmission. Our study underscores the need for standardized discharge pathways to help reduce readmissions after open lower extremity revascularization.