jueves, 3 de mayo de 2018

Hospital readmissions after elective lower extremity vascular procedures. - PubMed - NCBI

2017 Jan 1:1708538117728637. doi: 10.1177/1708538117728637. [Epub ahead of print]

Hospital readmissions after elective lower extremity vascular procedures.

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Abstract

Background This study evaluated risk factors associated with 30-day readmission after open and endovascular lower extremity revascularization. Methods Patients admitted with peripheral artery disease and lower extremity procedures were selected from national electronic medical record data, Cerner Health Facts® (2008-2014). Thirty-day readmission was determined. Logistic regression models identified characteristics independently associated with readmission. Results There were 2781 open and 2611 endovascular procedures. Readmission was 10.9% (9.6% open versus 12.3% endovascular, p<.0001). Greater disease severity was associated with readmission for both groups. Readmission factors for lower extremity bypass: blood transfusions (OR 2.25, 95% CI 1.62-3.13), hyponatremia (OR 1.72, 95% CI 1.15-2.57), heart failure (OR 1.57, 95% CI 1.07-2.29), bronchodilators (OR 1.50, 95% CI 1.13-2.00), black race (OR 1.43, 95% CI 1.03-1.99), and hypokalemia (OR 0.43, 95% CI 0.20-0.95). Readmission factors for endovascular procedures: vasodilators (OR 1.63, 95% CI 1.22-2.16), end-stage renal disease (OR 1.43, 95% CI 1.02-2.01), fluid and electrolyte disorders (OR 1.44, 95% CI 1.00-2.06), hypertension (OR 1.33, 95% CI 0.99-1.76), coronary artery disease (OR 1.31, 95% CI 1.02-1.67), and diuretics (OR 1.30, 95% CI 1.01-1.70). Conclusions Readmission after lower extremity revascularization is associated with disease severity for both procedures. Factors associated with readmission following lower extremity bypass included heart failure, transfusions, hyponatremia, black race, and bronchodilator use. Risk factors for endovascular readmissions were often chronic conditions including coronary artery disease, kidney disease, hypertension, and hypertensive medications. Awareness of risk factors may help providers identify high-risk patients who may benefit from increased surveillance and programs to lower readmission.