Vascular Surgery Has Unique Readmission Characteristics

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Administrative data show that readmission rates are highest in vascular surgery, according to Dr. Natalia O. Glebova and her colleagues. In Friday afternoon’s Plenary Session, Dr. Glebova, of the University of Colorado Denver, will present an analysis that she and her colleagues conducted to examine the particular contributions of planned readmissions and patient comorbidities to high readmission rates in vascular surgery.

“Hospital readmissions are increasingly being scrutinized as a metric of poor quality of health care and penalized by the Centers for Medicare and Medicaid Services (CMS),” according to Dr. Glebova.

“Readmissions in vascular surgery patients in particular have been found to be more frequent as compared to other surgical specialties. As CMS is starting to penalize surgical readmissions, and may penalize readmissions after vascular surgery, this study is timely in that it investigates the reasons behind the high readmission rates in vascular surgery patients.”

She and her colleagues queried the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset for overall and unplanned readmissions and performed bivariable and multivariable risk adjustment analyses using patient comorbidities in order to compare the risks of overall and unplanned readmissions in vascular surgery as compared with other specialties.

Among 1,165,827 surgical patients, a total of 86,653 underwent a vascular operation. The rate of 30-day postoperative readmission for vascular surgery was 10.2% and 5.5% for other specialties, a significant difference at P < .0001.

However, planned readmissions were also significantly more frequent for vascular surgery than other specialties (8.8% vs. 5.4%). Using risk-unadjusted analysis, vascular patients had significantly higher risk for overall readmission (odds ratio 1.97) and unplanned readmission (OR 1.89), compared with the other specialties.

On bivariable analysis, vascular patients were found to be older (67 vs. 56 years) and had more comorbidities such as diabetes (31% vs. 14%), dialysis dependence (6.4% vs. 0.9%), ASA class III/IV status (84% vs. 41%), and many others (all with P < .0001).

“Our study shows that the incidence of 30-day readmission after vascular surgery appears high, but after risk adjustment, the risk of unplanned readmission is similar to other surgical patients,” Dr. Glebova said.

“It is important that physicians make sure that policy makers understand differences between vascular surgery patients and other specialty patients and how these differences influence readmissions.” VC

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