Skip Navigation LinksHome > October 2012 - Volume 256 - Issue 4 > Causes and Implications of Readmission After Abdominal Aorti...
Annals of Surgery:
doi: 10.1097/SLA.0b013e31826b4bfe
Papers of the 132nd ASA Annual Meeting

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*

Supplemental Author Material
Collapse Box

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.

© 2012 Lippincott Williams & Wilkins, Inc.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.