Ninety-day readmission risks, rates, and costs after common vascular surgeries

OBJECTIVES: There are relatively sparse data regarding readmission after vascular surgery. The goal of our study is to analyze readmission rates and hospital cost for several common open and endovascular surgical procedures.

METHODS: We accessed our local ACS NSQIP clinical database and hospital cost accounting for vascular surgery cases and their 30- and 90-day readmissions from January 1, 2010, to November 30, 2011. Direct hospital costs (DHC$) were analyzed during the index admission and for all readmissions. Risk factors were compared in the readmitted versus non-readmitted groups using parametric or non-parametric tests as appropriate. Significance was set at P < .05.

RESULTS: We identified 170 patients who were readmitted. The 30-day all-cause readmission rate was 9.1% and at 90 days almost doubled to 17.9%. When readmissions occurred, on average they added DHC$ (000's) 12.4 ± 12.3, comprising an additional 61.1% beyond index admission DHC$. Preoperative risk factors associated with 90-day readmission included chronic obstructive pulmonary disease (COPD) (P = .027), open wound/infection (P = .005), and functional dependence (P = .027). Readmissions had longer index operative duration (P = .031) and more often received transfusions within 72 hours of the index case (P = .031). Wound infections were associated with a 90-day readmission (P = .012), as was treated DVT (P = .032) and cerebrovascular or cardiovascular events (P = .013).

CONCLUSIONS: Ninety-day readmissions after common vascular surgeries occurred at about twice our 30-day rate. The use of endovascular procedures is associated with significant readmission cost. COPD, open wounds with infection, functional dependence, lengthy procedures, and transfusion are associated with 90-day readmission after vascular surgery.