Analysis of Patient Presentation to the ED within 90-Days of Infra-Inguinal Bypass

Postoperative re-presentation to healthcare causes distress to patients and increases resource utilization. However, patients that re-present but do not require readmission are often not factored in traditional quality improvement datasets. This study aimed to identify risk factors for emergency department (ED) visits without readmission following infra-inguinal bypass.

A retrospective cohort study was conducted, reviewing infra-inguinal bypass performed at QEII Health Sciences Center between January 1, 2020, and December 31, 2021, in Halifax, Nova Scotia. Data from the Vascular Quality Initiative database was merged with provincial ED records to identify patients presenting to the ED within 90 days postoperatively. Descriptive statistics and multivariable logistic regression were used to identify predictors of ED visits without readmission.

Of 232 infra-inguinal bypasses performed, 29% re-presented to the ED within 90 days. Eighty-four percent of ED visits did not result in readmission. Indications for re-presentation included noninfectious wound complications (33.1%), surgical site infections (19.7%), and nonwound complications (18.3%). Complaints unrelated to the primary procedure accounted for 26.1% of all ED visits. Discharge on dual antiplatelet therapy (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.30-9.68) or anticoagulants (OR 2.58, 95% CI 1.04-6.37) was associated with increased odds of re-presentation. Medication-controlled diabetes (OR 0.25, 95% CI 0.10-0.65) and urgent repair (OR 0.15, 95% CI 0.04-0.62) were associated with decreased odds of re-presentation.

A considerable proportion of patients re-present to the ED without readmission after infra-inguinal bypass, most frequently for wound complications. Targeted quality improvement initiatives addressing this group could reduce unnecessary healthcare use and improve outcomes.