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Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

Greenblatt, David Yu MD, MSPH*,†; Greenberg, Caprice C. MD, MPH*,†; Kind, Amy J.H. MD, PhD†,‡; Havlena, Jeffrey A. MS*; Mell, Matthew W. MD§; Nelson, Matthew T. BA*; Smith, Maureen A. MD, MPH, PhD*,†,‖; Kent, K. Craig MD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e31826b4bfe
Papers of the 132nd ASA Annual Meeting
Abstract

Objective: To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair.

Background Data: Centers for Medicare & Medicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed.

Methods: We analyzed elective AAA repairs over a 2-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries.

Results: A total of 2481 patients underwent AAA repair–-1502 endovascular aneurysm repair (EVAR) and 979 open aneurysm repair. Thirty-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). Although wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed—eg, bowel obstruction was common after open repair, and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors, including serious complications leading to prolonged length of stay and discharge destination other than home, had a profound influence on the probability of readmission. The 1-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (P < 0.001).

Conclusions: Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.

In Brief

In this retrospective cohort study, we analyzed elective abdominal aortic aneurysm repairs over a 2-year period from a national sample of Medicare beneficiaries. Thirty-day readmission rates were similar after endovascular aneurysm and open aneurysm repair (13.3% and 12.8%, respectively), and the majority of readmissions were due to complications of surgery. Postoperative events were the major predictors of readmission. The 1-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted.

Author Information

*Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, WI

Health Innovation Program, University of Wisconsin-Madison, WI

Division of Geriatrics, Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, WI

§Department of Surgery, Stanford University, Palo Alto, CA

Department of Population Health Sciences, University of Wisconsin-Madison, WI.

Reprints: K. Craig Kent, MD, Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-7375. E-mail: kent@surgery.wisc.edu.

Sources of Funding and Conflicts of Interest: Support for the work was provided by the Health Innovation Program (HIP) and the Clinical & Translational Science Award (CTSA) program, previously through the National Center for Research Resources (NCRR) grant 1UL1RR025011, and now by the National Center for Advancing Translational Sciences (NCATS) grant 9U54TR000021. Additional funding was provided by the School of Medicine & Public Health, University of Wisconsin-Madison, via the Wisconsin Partnership Program. Amy J.H. Kind is supported by a National Institute on Aging Beeson Career Development award (K23AG034551, National Institute on Aging, The American Federation for Aging Research, The John A. Hartford Foundation, The Atlantic Philanthropies, and The Starr Foundation).

Disclosure: The authors declare no conflicts of interest.

The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH), Centers for Medicare & Medicaid Services (CMS), or any other organization.

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© 2012 Lippincott Williams & Wilkins, Inc.